Herbalife supplements are considered to be a well-established cause of serious liver injury.
Herbalife Supplements and Liver Toxicity
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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
Herbalife is a multi-billion-dollar, multi-level marketing supplement company that was forced to pay hundreds of millions of dollars to settle charges of deception and corrupt business practices. It also holds the distinction of being the dietary supplement most frequently implicated in injuring the livers of consumers.
Herbal does not mean innocuous. Cases of severe liver toxicity associated with Herbalife supplements started to be published in 2007 around the world. As the accompanying editorial summarized, there were 22 cases of liver damage following Herbalife intake in those first two reports, with two patients developing fulminant liver failure requiring liver transplantation. Only one survived. The editorial concluded that this clearly shifts the risk-benefit ratio against their use. Maybe it’s contamination with chemicals or heavy metals, maybe due to contamination with a liver toxic bacteria found in implicated products.
Additional reports continued to be published, followed by rebuttals written by Herbalife company representatives, questioning cause-and-effect. It’s no small task, given that people were taking up to seventeen different Herbalife products at one time.
So how strong is the evidence? A key factor to look for is re-challenge tests, or “positive re-exposure.” Did someone decide to take the product again after their initial liver injury resolved, and did the symptoms return on re-challenge? Based on stringent causality assessment methods like positive re-exposure tests, cause and effect is considered probable for at least a few Herbalife products. They are such a moving target though, with “hundreds of different products marketed globally in over 88 markets where in many cases the formula is unique to a country or region …”
Positive rechallenge cases continue to be published, confirming the toxic cause of liver damage from Herbalife products, perhaps by triggering an autoimmune reaction. This fatal case of a 24-year-old woman was attributed to Herbalife products, which were evidently found to contain heavy metals, traces of a psychotropic recreational agent, and pathogenic bacteria. This paper was subsequently taken down for “legal reasons” after legal threats by Herbalife.
LiverTox is a federal initiative between the National Institutes of Health and the National Library of Medicine to categorize the likelihood that substances can damage the liver, all the way up to the highest likelihood—Category A—meaning it is a well-known, well-described, and well-reported cause of liver damage. And that’s exactly how it characterized Herbalife supplements: A well-established cause of clinically apparent liver injury.
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- Stickel F, Shouval D. Hepatotoxicity of herbal and dietary supplements: an update. Arch Toxicol. 2015;89(6):851-865.
- Herbalife Will Restructure Its Multi-level Marketing Operations and Pay $200 Million For Consumer Redress to Settle FTC Charges. Federal Trade Ccmmission. FTC.gov. July 15, 2016.
- Herbalife Agrees To Pay $123 Million To Resolve Foreign Corrupt Practices Act Case. U.S. Attorney’s Office, Southern District of New York. Aug 2020.
- Assis MH de, Alves BC, Luft VC, Dall’alba V. Liver injury induced by herbal and dietary supplements: a pooled analysis of case reports. Arq Gastroenterol. 2022;59(4):522-530.
- Schoepfer AM, Engel A, Fattinger K, et al. Herbal does not mean innocuous: ten cases of severe hepatotoxicity associated with dietary supplements from Herbalife products. J Hepatol. 2007;47(4):521-526.
- Elinav E, Pinsker G, Safadi R, et al. Association between consumption of Herbalife nutritional supplements and acute hepatotoxicity. J Hepatol. 2007;47(4):514-520.
- Stickel F. Slimming at all costs: Herbalife-induced liver injury. J Hepatol. 2007;47(4):444-446.
- Stickel F, Droz S, Patsenker E, Bögli-Stuber K, Aebi B, Leib SL. Severe hepatotoxicity following ingestion of Herbalife nutritional supplements contaminated with Bacillus subtilis. J Hepatol. 2009;50(1):111-117.
- Jurčić D, Gabrić M, Troskot Perić R, et al. Herbalife® associated severe hepatotoxicity in a previously healthy woman. Acta Clin Croat. 2019;58(4):771-776.
- Chen GC, Ramanathan VS, Law D, et al. Acute liver injury induced by weight-loss herbal supplements. World J Hepatol. 2010;2(11):410-415.
- Ballotin VR, Bigarella LG, Brandão AB de M, Balbinot RA, Balbinot SS, Soldera J. Herb-induced liver injury: Systematic review and meta-analysis. World J Clin Cases. 2021;9(20):5490-5513.
- Appelhans K, Smith C, Bejar E, Henig YS. Revisiting acute liver injury associated with Herbalife products. World J Hepatol. 2011;3(10):275-277.
- Appelhans K, Frankos V, Shao A. Misconceptions regarding the association between Herbalife products and liver-related case reports in Spain. Pharmacoepidemiol Drug Saf. 2012;21(3):333-334; author reply 335.
- Appelhans K, Najeeullah R, Frankos V. Considerations regarding the alleged association between Herbalife products and cases of hepatotoxicity. Intern Emerg Med. 2014;9(5):599-600.
- Appelhans K, Najeeullah R, Frankos V. Deficiencies identified in dated case reports associated with Herbalife. J Pharm Pract. 2015;28(5):484-485.
- Teschke R, Frenzel C, Schulze J, Schwarzenboeck A, Eickhoff A. Herbalife hepatotoxicity: Evaluation of cases with positive reexposure tests. World J Hepatol. 2013;5(7):353-363.
- Teschke R, Wolff A, Frenzel C, Schulze J, Eickhoff A. Herbal hepatotoxicity: a tabular compilation of reported cases. Liver Int. 2012;32(10):1543-1556.
- Bessone F, García-Cortés M, Medina-Caliz I, et al. Herbal and dietary supplements-induced liver injury in Latin America: experience from the LATINDILI network. Clin Gastroenterol Hepatol. 2022;20(3):e548-e563.
- Philips CA, Augustine P, Rajesh S, et al. Slimming to the death: Herbalife®-associated fatal acute liver failure-heavy metals, toxic compounds, bacterial contaminants and psychotropic agents in products sold in India. J Clin Exp Hepatol. 2019;9(2):268-272.
- Philips CA, Augustine P, Rajesh S, et al. Removal notice to “slimming to the death: Herbalife® associated fatal acute liver failure – heavy metals, toxic compounds, bacterial contaminants and psychotropic agents in products sold in India”, [J Clin Exp Hepatol 9 (2019) 268–272]. J Clin Exp Hepatol. 2020;10(1):100.
- Piller C. Failing the test. Science. 2022;375(6580):484-489.
- Categorization of the likelihood of drug induced liver injury. In: LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. National Institute of Diabetes and Digestive and Kidney Diseases; 2012.
- Herbalife. In: LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. National Institute of Diabetes and Digestive and Kidney Diseases; 2012.
Motion graphics by Avo Media
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
Herbalife is a multi-billion-dollar, multi-level marketing supplement company that was forced to pay hundreds of millions of dollars to settle charges of deception and corrupt business practices. It also holds the distinction of being the dietary supplement most frequently implicated in injuring the livers of consumers.
Herbal does not mean innocuous. Cases of severe liver toxicity associated with Herbalife supplements started to be published in 2007 around the world. As the accompanying editorial summarized, there were 22 cases of liver damage following Herbalife intake in those first two reports, with two patients developing fulminant liver failure requiring liver transplantation. Only one survived. The editorial concluded that this clearly shifts the risk-benefit ratio against their use. Maybe it’s contamination with chemicals or heavy metals, maybe due to contamination with a liver toxic bacteria found in implicated products.
Additional reports continued to be published, followed by rebuttals written by Herbalife company representatives, questioning cause-and-effect. It’s no small task, given that people were taking up to seventeen different Herbalife products at one time.
So how strong is the evidence? A key factor to look for is re-challenge tests, or “positive re-exposure.” Did someone decide to take the product again after their initial liver injury resolved, and did the symptoms return on re-challenge? Based on stringent causality assessment methods like positive re-exposure tests, cause and effect is considered probable for at least a few Herbalife products. They are such a moving target though, with “hundreds of different products marketed globally in over 88 markets where in many cases the formula is unique to a country or region …”
Positive rechallenge cases continue to be published, confirming the toxic cause of liver damage from Herbalife products, perhaps by triggering an autoimmune reaction. This fatal case of a 24-year-old woman was attributed to Herbalife products, which were evidently found to contain heavy metals, traces of a psychotropic recreational agent, and pathogenic bacteria. This paper was subsequently taken down for “legal reasons” after legal threats by Herbalife.
LiverTox is a federal initiative between the National Institutes of Health and the National Library of Medicine to categorize the likelihood that substances can damage the liver, all the way up to the highest likelihood—Category A—meaning it is a well-known, well-described, and well-reported cause of liver damage. And that’s exactly how it characterized Herbalife supplements: A well-established cause of clinically apparent liver injury.
Please consider volunteering to help out on the site.
- Stickel F, Shouval D. Hepatotoxicity of herbal and dietary supplements: an update. Arch Toxicol. 2015;89(6):851-865.
- Herbalife Will Restructure Its Multi-level Marketing Operations and Pay $200 Million For Consumer Redress to Settle FTC Charges. Federal Trade Ccmmission. FTC.gov. July 15, 2016.
- Herbalife Agrees To Pay $123 Million To Resolve Foreign Corrupt Practices Act Case. U.S. Attorney’s Office, Southern District of New York. Aug 2020.
- Assis MH de, Alves BC, Luft VC, Dall’alba V. Liver injury induced by herbal and dietary supplements: a pooled analysis of case reports. Arq Gastroenterol. 2022;59(4):522-530.
- Schoepfer AM, Engel A, Fattinger K, et al. Herbal does not mean innocuous: ten cases of severe hepatotoxicity associated with dietary supplements from Herbalife products. J Hepatol. 2007;47(4):521-526.
- Elinav E, Pinsker G, Safadi R, et al. Association between consumption of Herbalife nutritional supplements and acute hepatotoxicity. J Hepatol. 2007;47(4):514-520.
- Stickel F. Slimming at all costs: Herbalife-induced liver injury. J Hepatol. 2007;47(4):444-446.
- Stickel F, Droz S, Patsenker E, Bögli-Stuber K, Aebi B, Leib SL. Severe hepatotoxicity following ingestion of Herbalife nutritional supplements contaminated with Bacillus subtilis. J Hepatol. 2009;50(1):111-117.
- Jurčić D, Gabrić M, Troskot Perić R, et al. Herbalife® associated severe hepatotoxicity in a previously healthy woman. Acta Clin Croat. 2019;58(4):771-776.
- Chen GC, Ramanathan VS, Law D, et al. Acute liver injury induced by weight-loss herbal supplements. World J Hepatol. 2010;2(11):410-415.
- Ballotin VR, Bigarella LG, Brandão AB de M, Balbinot RA, Balbinot SS, Soldera J. Herb-induced liver injury: Systematic review and meta-analysis. World J Clin Cases. 2021;9(20):5490-5513.
- Appelhans K, Smith C, Bejar E, Henig YS. Revisiting acute liver injury associated with Herbalife products. World J Hepatol. 2011;3(10):275-277.
- Appelhans K, Frankos V, Shao A. Misconceptions regarding the association between Herbalife products and liver-related case reports in Spain. Pharmacoepidemiol Drug Saf. 2012;21(3):333-334; author reply 335.
- Appelhans K, Najeeullah R, Frankos V. Considerations regarding the alleged association between Herbalife products and cases of hepatotoxicity. Intern Emerg Med. 2014;9(5):599-600.
- Appelhans K, Najeeullah R, Frankos V. Deficiencies identified in dated case reports associated with Herbalife. J Pharm Pract. 2015;28(5):484-485.
- Teschke R, Frenzel C, Schulze J, Schwarzenboeck A, Eickhoff A. Herbalife hepatotoxicity: Evaluation of cases with positive reexposure tests. World J Hepatol. 2013;5(7):353-363.
- Teschke R, Wolff A, Frenzel C, Schulze J, Eickhoff A. Herbal hepatotoxicity: a tabular compilation of reported cases. Liver Int. 2012;32(10):1543-1556.
- Bessone F, García-Cortés M, Medina-Caliz I, et al. Herbal and dietary supplements-induced liver injury in Latin America: experience from the LATINDILI network. Clin Gastroenterol Hepatol. 2022;20(3):e548-e563.
- Philips CA, Augustine P, Rajesh S, et al. Slimming to the death: Herbalife®-associated fatal acute liver failure-heavy metals, toxic compounds, bacterial contaminants and psychotropic agents in products sold in India. J Clin Exp Hepatol. 2019;9(2):268-272.
- Philips CA, Augustine P, Rajesh S, et al. Removal notice to “slimming to the death: Herbalife® associated fatal acute liver failure – heavy metals, toxic compounds, bacterial contaminants and psychotropic agents in products sold in India”, [J Clin Exp Hepatol 9 (2019) 268–272]. J Clin Exp Hepatol. 2020;10(1):100.
- Piller C. Failing the test. Science. 2022;375(6580):484-489.
- Categorization of the likelihood of drug induced liver injury. In: LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. National Institute of Diabetes and Digestive and Kidney Diseases; 2012.
- Herbalife. In: LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. National Institute of Diabetes and Digestive and Kidney Diseases; 2012.
Motion graphics by Avo Media
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Herbalife Supplements and Liver Toxicity
LicenseCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Content URLDoctor's Note
This video was scripted by our new Senior Research Scientist, Dr. Kristine Dennis. In the future, she may even start narrating some of her videos!
For more on the sad state of supplement regulation, check out:
- Some Dietary Supplements May Be More Than a Waste of Money
- Dangers of Dietary Supplement Deregulation
- Supplement Regulation and Side Effects: Efforts to Suppress the Truth
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