Hoodwinked By Hoodia?

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Q: I was taking Hoodia supplements for weight loss and developed gastrointestinal problems that included diarrhea. I was admitted to the hospital and my liver blood test was abnormally high at 101. I have since stopped taking the Hoodia pills. Will my liver blood test return to normal?

A: Hoodia by itself does not generally cause liver problems in people with normal and healthy livers. That said, while I understand you bought a product listing Hoodia on its label, dietary supplements are not regulated. This makes it possible your product contained other ingredients (including contaminants) that led to your illness. Also, there may be other reasons (diet, medication, alcohol, infection, diabetes, obesity, etc.) for your symptoms and abnormal liver blood test.

The liver is an organ that plays many vital roles in our body. It aids in the digestion of dietary fat by secreting bile into the intestine, helps to purify and remove potentially harmful chemicals, and produces important substances (proteins, others) that are necessary for our good health. If the liver’s health is harmed in some way, specific blood tests are checked.

These include but aren’t limited to:

Aspartate aminotransferase (AST or SGOT)
Alanine aminotransferase (ALT or SGPT)
Gamma glutamyl transpeptidase (GGTP)
Alkaline phosphatase

Abnormal results on any or all of these tests would mean further specific testing would be needed. Your doctor would need to determine whether the cause was from a liver problem or due to another condition. Potential concerns include but aren’t limited to:

Hepatitis A, B or C
Medications (steroids, synthetic estrogens, statins, acetaminophen, amiodarone, ibuprofen, naproxen, others)
Autoimmune hepatitis
Crohn’s disease and ulcerative colitis
Celiac sprue
Hemachromatosis
Diabetes
Alcohol abuse
Cancer

Additional diagnostic tests your doctor may order include but aren’t limited to:

Repeat liver blood tests to see if they are returning to normal
An ultrasound, which uses sound waves to produce a “picture” of your liver
Computerized tomography (CT scan) to view cross-sectional images
Magnetic resonance imaging (MRI)
A biopsy of your liver if blood tests continue to be abnormally high in spite of lifestyle adjustments (stop alcohol, lose weight) and/or treatment

Getting back to your question, it is not unusual for some people to have very mild liver disease without any outward symptoms. In fact, the only way we know there is a problem is through routine blood tests that check the liver. So, it is possible your elevated ALT had been in that range for a long while, especially since your stated height and weight calculate to a body mass index of 27.5. This means you are most likely overweight with an increased amount of body fat. Many people don’t realize that puts them at a higher risk for a condition known as a fatty liver; in its earliest stage, there usually are no symptoms with normal or mildly elevated liver enzymes. If the condition progresses, nausea, fatigue and a general ache in your right upper abdominal area may occur. If this is the reason for your elevated ALT, a 10 percent to 15 percent weight loss will help to normalize your result.

I applaud your decision to get to a healthier weight. You should meet with a registered dietician to ensure a diet plan that is right for you. In regard to your selection of a product to aid in weight loss, it is important to know that dietary supplements can, and often do, act like medications. But unlike prescription and non-prescription drugs, they do not undergo the same testing of the specific ingredients. While many companies follow high quality standards, some don’t. The result: Some supplements may contain more, less, or none of the advertised ingredients on the label—and there have been cases where harmful contaminants were present. In other words: Buyer beware. This makes it especially important to speak with your physician and pharmacist before taking any supplement. They can help determine if the product you are considering is safe and effective, and whether it will interfere with any medical condition or medication.

If the particular supplement is right for you, the next step is to ensure it is of high quality. Look for approvals from Consumer Lab (CL) or United States Pharmacopeia (USP)-verified. This verifies the product contains the ingredients in the stated amounts and strengths, does not contain harmful contaminants, and has been produced using good manufacturing practices.

Lastly, anyone who is discovered to have abnormal liver blood tests should have a full evaluation by their family doctor, internist or gastroenterologist. For further information, please check out the National Library of Medicine and the National Institutes of Health and the American Liver Foundation.

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)