GA S T RO E N T E RO LO G Y Nonprescription Supplements and Pain Relievers Contribute to Liver Damage The overuse of nutritional supplements and nonprescription pain relievers like acetaminophen is contributing to a growing incidence of serious liver damage caused by these chemical agents, a condition known as hepatotoxicity. “A patient has a medical or dental procedure and afterward has a lot of pain, so he or she starts taking large numbers of acetaminophen and develops toxicity that is potentially fatal without a liver transplant,” says UCLA gastroenterologist Francisco Durazo, MD. Nutritional supplements are cause for similar concern. More than half of Americans take supplements, Dr. Durazo notes, and consumption of herbal medications has increased fivefold in the last decade. “We’re now starting to see the effects,” he says. The most common supplement-induced liver injuries result from workout or bodybuilding supplements, with weight-loss supplements not far behind. Less common but still important to be aware of, he adds, are injuries from consuming large quantities of popular energy drinks. It is important that patients talk with their physicians about any nonprescription products they are taking, and for physicians to offer counsel on the potential dangers of misuse, Dr. Durazo says. In the case of acetaminophen, patients also need to be aware that it can be present in other medications, from analgesics to cold remedies. Dr. Durazo cautions that certain factors can predispose someone to increased acetaminophen toxicity, including heavy alcohol use, fasting and medications that speed up the metabolism. When it comes to nutritional supplements — be they workout-enhancing supplements, weight-loss pills or energy-boosting drinks — the problem is compounded by misleading advertising and labeling, contends Fady M. Kaldas, MD, director of the liver-transplant service at the Dumont- UCLA Transplant Center. “There is a big market for people who want to move away from Western medicine and buy something UCLAHEALTH.ORG 1-800-UCLA-MD1 (1-800-825-2631)