Dying for an energy drink?

early-morning-workout-tips-300x200As someone who gets up at 4:30 am most days to go to the gym and who rarely, if ever, eats carbs, I know there is no easy way to stay fit and healthy.  But, there are others who may be tempted to look for an easier or quicker way…and to them we say- beware!

Before you reach for a weight loss supplement, or energy drink, you may want to think again. According to four separate case reports just presented at the American College of Gastroenterology’s 78th Annual Scientific Meeting in San Diego, consumption of some of these can lead to hepatitis, severe liver damage, liver failure and even death.

energy drinksUse of herbal and dietary supplements is widespread for a variety of reasons. But many patients don’t disclose supplement use to their physicians, and as such important drug side effects can be missed.

The first case report documented a case over liver toxicity and fulminant liver failure associated with the use of SlimQuick™, a weight loss supplement containing green tea extract.

A 52-year old female patient was admitted to the emergency room after one week of vomiting and progressive jaundice. The patient reported she had ingested SlimQuick™ for two days, while fasting three weeks prior to admission. Her liver biopsy was consistent with hepatic necrosis She was started on steroids but these were discontinued after two days, as liver function worsened and mental status deteriorated to the point she needed to undergo liver transplantation two days later.

In the second paper, Khadija Haroon Chaudrey, MD, presented a rare case of black cohosh-induced hepatotoxicity leading to early cirrhosis. Black cohash is often used by menopausal women to control hot flashes and other associated symptons

A 44-year-old female had developed jaundice for one month, and initial lab work revealed elevated liver function tests (LFTs). The patient had no history of alcohol intake, IV drug use, unprotected sex, recent travel outside the United States, NSAID ingestion or blood transfusions. After an unsuccessful outpatient trial of steroids, she was referred for inpatient evaluation because of gradual progression of her symptoms.

cirrhosis1The patient then reported she had started taking black cohosh about one month prior. “Her ultrasound abdomen showed nodular contour of liver consistent with cirrhosis,” said Dr. Chaudrey. “Given patient’s history of black cohosh use and the timing of her abnormal liver chemistries, it was clinically evident the culprit agent was black cohosh.”

Once the patient stopped taking black cohosh, her symptoms improved and her LFTs normalized.

The third case described acute liver failure following consumption of Rockstar® Sugar Free energy drink.

Brian Huang M.D., Chief Resident of the Internal Medicine Residency Program at Cedars Sinai Medical Center, presented a case involving a 36-year-old male without prior medical history. He sought medical attention after symptoms of right upper quadrant abdominal pain, jaundice and fatigue. After abnormal lab work, he was brought to the hospital. The patient admitted to binge drinking (10 beers in a three-hour period) prior to symptom onset. He denied consuming herbal supplements, but admitted to having three Rockstar® Sugar Free energy drinks, on a daily basis for the past year. He too, required a liver transplant.

According to Dr. Huang, “The patients’ pathology reports showed massive hepatocellular necrosis and parenchymal collapse consistent with drug-induced liver injury. We believe his prior history of binge drinking may have provided initial damage on his liver, making him more susceptible to develop liver failure. Although the patient had a history of weekend binge drinking, his liver biopsy was not consistent with alcoholic hepatitis. Thus, they determined that the liver failure was linked to the long-term energy drink consumption.

A fourth case of drug-induced liver injury was found to be associated with the advanced weight loss supplement, Ripped Fuel®. This supplement contains herbal extract with 60% flavinoids, caffeine and cacao.

scleral icterusA 36-year old female with history of depression and no prior liver disease was seen after having one week of abdominal pain, anorexia and nausea. On physical examination, she had jaundice and yellowing of her eyes. The patient had started to take Ripped Fuel® three weeks prior to developing these symptoms, to lose weight. She denied use of other herbal medicine, supplements or acetaminophen. There had been no recent changes in her depression medication.

There is a lack of knowledge about the status of Food and Drug Administration regulation of dietary supplements,” said Dr. Halegoua-De Marzio, author of the first paper. “Currently, dietary supplements are not required to have safety or efficacy studies before they are marketed to the public, and they remain popular among consumers despite reports of hepatotoxicity. 

These cases serve as a reminder of how even minimal use of dietary supplements can lead to liver failure and liver transplant. It is important that patients talk with their doctors before starting any new dietary supplements.

Or better yet, stick with the old fashioned way of healthy diet and exercise.  So who wants to join me in the gym at 5am tomorrow?

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Manicure and pedicure – $100… avoiding hepatitis – priceless.

Having survived the ghostly ghoulishness of Halloween, those of us living in Virginia thought we could rest easy for the next year.  Not so.  According to a new report, a mani-pedi could result in way more than beautiful nails.

The study by the Virginia Department of Health entitled, “Assessment of the Risk of Bloodborne Pathogen Transmission in Nail Salons and Barber Shops and Regulatory Requirements in Virginia” concluded that the risk of disease transmission cannot be excluded.

And although the current Virginia regulations (dated September 1, 2011), are sufficient to preventing bloodborne pathogens transmission, there is little evidence to show that they are being followed.  David A. Johnson, M.D., FACG of Eastern Virginia Medical School who analyzed the report said “The risk of transmission of infectious disease, particularly hepatitis B and C, in personal care settings is significantly understudied in the United States.”

Repeat use instruments such as nail files, finger bowls, foot basins, buffers, clippers, and scissors all constitute a threat if they are not fully cleaned and disinfected.

A recent case of acute hepatitis C (HCV), a disease that can result in liver chirrosis, liver cancer and even death, was “clearly related to a manicure/pedicure treatment” said Johnson.  This case prompted the evaluation of the current safety regulations in Virginia and compared them with those in 13 other states and the District of Columbia.  This review of the published literature identified eighteen papers, including nine case-control studies, three case-series studies, and six population-based surveys, that assessed manicure, pedicure, or barbering as potential risk factors for hepatitis B (HBV) and/or HCV infection. Of the nine case-control studies, five evaluated HBV and/or HCV in nail salon settings and three of the five showed association with HBV and one of the five showed association with HCV.

Uggggh!   Nevertheless, caution is required in interpreting these findings because of the substantial heterogeneities in the population studied, sample size, case and control selection, analytic method, and control of confounding variables across studies. Furthermore, none of the nine case-control studies was conducted in the United States.

The federal Occupational Safety and Health Administration (OSHA) does not have specific guidelines for the prevention of HBV or HCV infection in nail salons and neither the current CDC case report form for HBV or HCV nor the National Electronic Disease Surveillance System captures manicures or pedicures as risk factors for transmission of hepatitis.

“The true magnitude of this risk has yet to be defined and clearly needs further study,” commented Dr. Johnson.

In the meantime, he urged nail salon customers to be aware of the potential risks for hepatitis transmission, and to take precautions including asking questions to determine whether or not the establishment is properly cleaning and disinfecting their equipment. “No one should accept on blind trust that a business is taking the necessary steps to prevent transmission of bloodborne infections such as hepatitis,” said Johnson.

SRxA’s Word on Health won’t be giving up our well earned trips to the salon just yet…but we will probably starting bringing our own clippers, and nail files with us .