Liver injury seen in patients using excessive herbal immune boosters like giloy in Covid time

Liver injury cases are being reported in patients taking ayurvedic medications indiscriminately, experts have said.

A study published in the journal of clinical and experimental hepatology says herbal immune booster-induced liver injury during Covid-19 "may arise from direct and indirect mechanisms through the metabolites of the herb or their interactions with other drugs, including contaminants."

The researchers say they documented the experience of six patients with herbal-induced liver injury from September 2020 to December 2020.

Here is what the study found:

1st patient- A previously healthy 40-year-old male without co-morbidities presented with jaundice of 15 days duration. He was found to be a habitual consumer of TC plant twigs (10 to 12 pieces) boiled with cinnamon and cloves in half a glass of water, once in two days, for three months prior to presentation.

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TC or Tinospora Cordifolia is an Indian herb popularly used for its "immunity booster" effects during the pandemic. TC is known by different names in various Indian languages. Other names are Guduchi and Giloy.

He was followed up for five months till complete resolution of symptoms and normalisation of liver function, the researchers say.

2nd patient- A 54-year-old female, with type-2 diabetes mellitus, presented with jaundice for one week. A seven-month history of unsupervised consumption of the TC plant (1 twig per day), which was boiled and extract consumed was obtained.

3rd patient- A 38-year-old male with Beta-thalassemia minor presented with jaundice for one week duration. He gave the history of consumption of 3-4 TC plant twigs - boiled and consumed 15 ml/day - for six months prior to the presentation.

4th patient- A 62-year-old female with type-2 diabetes mellitus, presented with complaints of malaise, reduced appetite and yellowish discolouration of urine, eyes and skin with abdominal distension for 15 days. She confirmed consumption of commercially available syrup containing TC plant - 15 ml/day, every alternate day for a month, prior to the onset of her symptoms.

The fifth and the sixth patients too were patients of Jaundice, with liver functioning effectively reduced. Both had a history of consumption of TC/Giloy/Guduchi.

WHAT DOES THE MINISTRY OF AYUSH SAY?

The government has advised the use of Giloy, but has urged caution against indiscriminate use and self-medication. The treatment protocol as per the Ministry of Ayush says Giloy should be consumed " 500 mg extract or 1-3 g powder twice daily with warm water for 15 days or one month or as directed by an Ayurveda physician."

EXPERTS SPEAK:

'Giloy' (common name for the herb Tinospora) or 'Guduchi' is a particular favorite. When taken for prolonged periods, unfortunately, some have suffered liver toxicity due to it. Tinospora Crispa is the herb which is the usual culprit. We have seen 5 such cases of Giloy-induced liver damage especially in those who took it for longer than 2-3 months. " Dr Arvinder Singh Soin, Chairman, Medanta Liver Transplant Institute, told India Today.

He also says that patients with baseline liver damage due to diabetes or alcohol are more susceptible. On biopsy, these patients exhibit features of DILI (drug-induced liver injury) and autoimmune hepatitis.

SOME PATIENTS RECOVER, DEATH ALSO A POSSIBILITY

Dr Soin says that he has seen recoveries in patients who typically improve 3-6 weeks after discontinuing the herb. But some with pre-existing liver damage may go into advanced liver failure. "One of our patients, who sadly died before he could be transplanted," Soin says.

The majority of them are not backed by scientific trials to define correct doses and adverse effects. That's why some people may benefit, but an unpredictable number may also be harmed by them.

Dr. K. Venugopal, Sr. Consultant - HPB Surgery & Liver Transplantation, Yashoda Hospitals, says, "We have to be very watchful and careful in taking medications in persons known to have liver disease, avoiding those which are likely to affect or harm the liver or other organs. Any medication from any discipline has to be taken only on proper prescription, with a need to follow them thereafter. Self-remedies and those based on unfounded sources need to be avoided."