Marked Transaminase Elevations and Worsening Glycemic Control Associated With Counterfeit Polyherbal Use in a Patient With Diabetes

Dietary and herbal supplements, a US$20.3 billion entity, are used by more than half of the adult population in the United States. Since weight loss is beneficial in obese patients at high risk for cardiovascular disease, many obese Americans are ingesting herbal weight loss supplements under the assumption that they are inherently safe. We report the case of a 55-year-old morbidly obese Caucasian female with diabetes, who started multiple polyherbal supplements. Six months after starting several herbal products, the patient’s A1C increased from 7.8% to 9.4% and the AST/ALT were markedly elevated. After discontinuation, transaminases normalized in 28 days. On follow-up visit, the patient reported compliance with prescribed medications and denied use of herbal products. The patient’s A1C approached target goal. The potential for counterfeit herbal supplement production exists. Our patient’s products were analyzed for purity, and 0% Hoodia gordonii was found. A misconception of herbal products is that they are safe because they are natural. Unfortunately, many natural products can act in the same capacity as drugs, educing both benefit and harm. Health care providers, particularly pharmacists, should be aware of counterfeit herbal supplements and closely monitor for dangers of herbal supplement use.