Saturday, December 1, 2012


Acute liver injury induced by   weight-loss herbal supplements 
  World J Hepatol. 2010 November 27; 2(11): 410-415.        Published online 2010 November 27. doi: 10.4254/wjh.v2.i11.410.

We report three cases of patients with acute liver injury induced by weight-loss herbal supplements. One patient took Hydroxycut while the other two took Herbalife supplements. Liver biopsies for all patients demonstrated findings consistent with drug-induced acute liver injury. To our knowledge, we are the first institute to report acute liver injury from both of these two types of weight-loss herbal supplements together as a case series. The series emphasizes the importance of taking a cautious approach when consuming herbal supplements for the purpose of weight loss.

We have seen a significant increase in the popularity and usage of over the counter herbal supplements over the past few years[1]. Unfortunately, the majority of these herbal supplements are not regulated by drug administrations worldwide. Many herbal supplements contain compounds that carry potentially severe side effects including hepatotoxicity. We report three cases of acute liver injury induced by weight-loss herbal supplements. Hydroxycut (MuscleTech, Mississauga, Ontario, Canada) (case 1) and Herbalife (Herbalife, Los Angeles, USA) (cases 2 and 3) supplements were the suspected culprits of acute liver injury. Hydroxycut is a popular dietary supplement consisting of a variety of herbal mixtures that claims to enhance the weight loss process[2]. Acute liver injury associated with Hydroxycut use has been previously reported, but only one case had liver biopsy data showing cholestasis and portal inflammation[3-6]. Similarly, Herbalife weight-loss dietary products are popular supplements consisting of a variety of herbal mixtures that claim to facilitate weight reduction[7]. Cases of acute liver injury after consumption of Herbalife products have been previously reported, with two patients developing fulminant liver failure requiring liver transplantation. The first patient survived while the second died[8-11]. In all of our cases, we were able to demonstrate drug-induced acute liver injury on liver biopsy specimens.

Case 1
A 31-year-old woman presented to our hospital complaining of 2-wk history of fatigue, jaundice, and nausea. She denied any prior medical or surgical conditions, family history of liver disease, and acetaminophen or prescription medication use. She further denied history of blood transfusion, tattoo, alcohol use, or recreational drug use. She had been taking Hydroxycut for one year to enhance her weight loss. She had been taking the recommended dose of 2 tablets twice a day.
The patient was afebrile with normal hemodynamics upon presentation. Her physical examination was remarkable for generalized jaundice, scleral icterus, and mild upper quadrant tenderness to palpation without rebound or guarding. Initial laboratory studies were significant for serum aspartate aminotransferase (AST) level of 1407 U/L (normal range 15-41), serum alanine aminotransferase (ALT) level of 1278 U/L (normal range 7-35), serum alkaline phosphatase of 256 U/L (normal range 38-126), serum total bilirubin (TB) of 7.1 mg/dL (normal range 0.2-1.2), and international normalized ratio (INR) of 1.3 I/U (normal range 0.8-1.2). Given these findings, patient was admitted to the hospital for a higher level of care.

Standard blood tests were negative for hepatitis A, B, C, E, Ebstein Barr virus (EBV), cytomegalovirus (CMV), human immunodeficiency virus (HIV), antinuclear antibody, anti-smooth muscle antibody, anti-liver/kidney microsomal antibody, alpha-1-antitrypsin deficiency, and anti-mitochondrial antibody. Serum acetaminophen and urine toxicity screens were negative. Serum ceruloplasmin, ferritin, iron studies, and immunoglobulins were all within the normal range. Right upper quadrant ultrasound showed diffuse echogenicity of the liver. Liver biopsy was performed and showed multi-lobular necrosis consistent with acute toxic necrosis and fulminant hepatitis (Figure 1).
Figure 1

Figure 1
Liver biopsy showed extensive patchy areas of multilobular necrosis with only bile ducts remaining, extensive ductal metaplasia, severe lymphocytic and macrophages infiltration of portal tracts and lobular parenchyma and patchy plasma cell infiltrates. Histological changes were consistent with acute troxis necrosis and fulminant hepatitis. A: Liver lobules showing massive necrosis with only bile ducts remaining (hematoxiline and eosin stain × 52); B: Lymphocytic infiltration of portal tract and lobular parenchyma (hematoxiline and eosin stain × 130); C: Liver lobular necrosis with macrophages cleaning the debris (CD68 stain × 130); D: Ductal metaplasia. Lymphocytic infiltration in the sinusoids (CAM5.2 stain × 260); E: High power, lymphocytes destroying hepatocytes (CAM5.2 stain × 520); F: Lymphocyte “eating” hepatocytes in a liver parenchyma (troxis necrosis), arrow showing immunological synapses (Electron microscopy × 15000).
The patient’s liver function tests peaked 4 d after admission with serum AST level of 1613 U/L, ALT level of 1227 U/L, serum alkaline phosphatase of 268 U/L, serum TB of 10.5 mg/dL, and INR staying at 1.3 I/U. She did not develop evidence of hypoglycemia or portal-systemic encephalopathy. Her jaundice and scleral icterus resolved over the following 2-wk. Her liver tests gradually improved within the following few months.
Case 2
A 37-year-old woman presented to our hospital with a 1-mo history of diffuse abdominal pain, mild nausea, and painless jaundice. She denied any past medical or surgical history, family history of liver disease, or any alcohol or illicit substance abuse. She admitted that she had been taking Herbalife dietary supplements for the past 3-mo in an attempt to lose weight. Her Herbalife regimen consisted of the Formula One Nutritional Shake Mix, the Multivitamin Complex, the Cell Activator, the Cell-U-Loss, the Herbal Concentrate Original, and the Total Control formula.
The patient was afebrile with normal vital signs on presentation. Her physical exam was noticeable for bilateral scleral icterus and generalized jaundice. Her abdominal exam revealed a non-tender, non-distended abdomen with no stigmata of liver disease. Initial laboratory studies were significant for an AST level of 2199 U/L, serum ALT level of 2068 U/L, serum alkaline phosphatase of 185 U/L, and TB of 15.3 mg/dL. All other laboratory values, including amylase, lipase, and INR, were within normal limits. Given these lab abnormalities, the patient was admitted to the hospital for further work-up.
Standard blood tests were negative for hepatitis A, B, C, E, EBV, CMV, HIV, antinuclear antibody, anti-smooth muscle antibody, anti-liver/kidney microsomal antibody, alpha-1-antitrypsin deficiency, and anti-mitochondrial antibody. Serum acetaminophen and urine toxicity screens were negative. Serum ceruloplasmin, ferritin, iron studies, and immunoglobulins were all within normal range. A computerized tomography (CT) scan of the abdomen and pelvis with intravenous (IV) contrast showed multiple low-density lesions in the liver measuring up to 8-mm. A liver biopsy revealed acute necrotizing hepatitis both centrolobular and periportal, consistent with a drug-induced etiology (Figure 2). However, her liver biopsy specimens also showed evidence of bridging fibrosis, which suggest some degree of chronic liver disease but with drug-induced injury in addition.
Figure 2
Figure 2
Liver biopsy was performed and showed periportal bridging fibrosis, ductal metaplasia, cholestasis, moderate intralobular lymphocytic infiltration, and troxis necrosis and apoptosis consistent with drug-induced hepatitis on top chronic liver disease. A: Liver showing periportal fibrosis and cholestasis (periodic acid-Schiff stain × 130); B: Portal tract showing ductal metaplasia and periportal fibrosis (AE1/AE3 stain × 260); C: Portal - portal bridging fibrosis (CAM5.2 stain × 52); D: Portal - portal bridging fibrosis (Reticulin stain × 52).
The patient was treated supportively with fluids and nutrition. Her liver tests steadily declined from the day of admission and on hospital day 8 (day of discharge) her liver tests revealed a AST level of 1788 U/L, ALT level of 1501 U/L, and serum alkaline phosphatase of 183 U/L. The only laboratory value to increase was the patient's serum TB, which was at 29.9 mg/dL on discharge. The patient did not develop encephalopathy, hypoglycemia, or any other complications. The patient was followed for several months, throughout which her symptoms continued to improve.
At her 2-mo follow-up, the patient's icterus and jaundice had resolved completely. Her labs at this time showed a serum AST level of 51 U/L, serum ALT level of 43 U/L, serum alkaline phosphatase of 65 U/L, and serum TB of 1.1 mg/dL.
Case 3
A 53-year-old previously healthy woman presented with a 3-wk history of painless jaundice and pruritus. She denied any family history of liver disease, or any alcohol or illicit substance abuse. She had not been taking any new prescribed medications. On further questioning about over-the-counter supplements she divulged a 4-mo history of consuming various Herbalife weight loss products in the form of shakes, teas and pills.
On physical exam the patient’s vital signs were within normal limits. On general inspection she had scleral icterus and jaundice, with evidence of excoriations. A 2-cm palpable liver edge could be appreciated, that was tender to touch. There were no other signs of chronic liver disease. Initial laboratory values revealed a hepatocellular pattern of injury, with an AST of 1282 U/L, ALT of 983 U/L, and alkaline phosphatase of 292 U/L, with a TB of 18.2 mg/dL. An ultrasound showed borderline hepatomegaly of 17-cm.
Standard blood tests for hepatitis A, B, C, E, EBV, CMV, HIV, antinuclear antibody, anti-smooth muscle antibody, anti-liver/kidney microsomal antibody, alpha-1-antitrypsin deficiency, and anti-mitochondrial antibody were negative. Serum acetaminophen and urine toxicity screens were negative. Serum ceruloplasmin, ferritin, iron studies, and immunoglobulins were all within normal range.
Liver biopsy was performed and showed cholestasis, consistent with drug induced hepatitis (Figure 3). 2-mo after complete abstinence from the Herbalife supplements her jaundice resolved, as did her liver tests.
Figure 3
Figure 3
A liver biopsy revealed acute hepatitis characterized by hepatocellular injury, with periportal fibrosis, cholestasis, ductal metaplasia and diffuse intralobular and periportal troxis necrosis consistent with a drug-induced etiology. Intralobular lymphocytic infiltration. Arrow showing apoptosis of hepatocytes (hematoxiline and eosin stain × 260).
Acute liver injury induced by over the counter weight-loss herbal supplement Hydroxycut and Herbalife products have been reported previously[3-6,8-11]. These case reports were limited by the fact that liver biopsies were performed in only a few patients, confirming clinical suspicions histologically. In terms of our patients, all three had liver biopsy performed and all showed some common morphological features including diffuse lymphocytic infiltration of sinusoids and portal tracts, ductal metaplasia and toxic necrosis. Some variations of morphological features could be explained by predominance of intrinsic or idiosyncratic mechanisms of hepatic injury, individual patient response to the affecting drug and duration of injury. The patients’ liver biopsy specimens were stained with periodic acid-Schiff (PAS) stain with diastase. No hyaline globules were identified in any of the three cases. The absence of histological findings and the fact that our patients had no history of chronic obstructive pulmonary disease excluded diagnosis of alpha-1-antitripsin deficiency in all three cases. Prussian blue and copper stains did not reveal excessive iron or copper depositions in the hepatocytes and Kupffer cells.
Only one previous case of Hydroxycut-induced acute liver injury had reported findings on liver biopsy. Although the most likely explanation for the mechanism of liver injury caused by these herbal products is idiosyncratic reaction, one of the ingredients in Hydroxycut, green tea extract (Camellia sinensis), has been linked with acute liver injury in other over the counter weight-loss herbal supplements[12-20]. In fact, the weight-loss herbal supplement Exolise (Arkophama, Carros, France), which also contained C. sinensis, was withdrawn from the market because it was linked to multiple cases of liver injury[13]. Furthermore, several cases of hepatotoxicity were associated with another herbal weight-loss supplement, Cuur (Scandinavian Clinical Nutrition, Sweden), which also contains the ethanolic dry extract of green tea (C. sinensis)[15]. Rechallenging patients with the same product led to hepatotoxicity, confirming the role of C. sinensis[12,16]. In all reported cases of acute liver injury induced by Hydroxycut, patients’ liver function tests recovered over time following cessation of the product. However, there have been cases of liver failure caused by green tea extract C. sinensis, requiring orthotopic liver transplantation[13,16].
The liver biopsy obtained in our patient who took Hydroxycut showed multi-lobular necrosis consistent with acute toxic necrosis and fulminant hepatitis. These findings are similar to the findings in patients with liver injury associated with green tea extract C. sinensis, where prominent necrosis with inflammatory reaction is the hallmark presentation[15,16].
The exact mechanism of hepatotoxicity induced by Hydroxycut is unknown. However, as this product contains green tea extract C. sinensis, it is possible that this may play a role in acute liver injury caused by Hydroxycut. Prior investigation into the mechanism of hepatotoxicity by green tea extract was inconclusive[21]. Others have hypothesized that a possible allergic reaction to the green tea extract, contamination during the production of the extract or a metabolic idiosyncrasy are possible mechanisms of liver injury in these patients[16].
Both of our patients took several Herbalife weight-loss herbal products concurrently, similar to most of the previously reported cases of hepatotoxicity due to Herbalife products[8-11]. Therefore, it is difficult to identify the exact ingredient or mechanism that causes the liver injury, as in the previously documented cases[8-11]. In a previously reported case, one investigator was able to isolate contamination with Bacillus subtilis, in which the bacterial supernatant caused dose-dependent increase of LDH leakage in HepG2 cells[8]. Although not commonly known as a human pathogen, B. subtiliis has been reported to cause food poisonings and a case of cholangitis in an immunocompromised patient[22-23]. Investigators have also suggested that another explanation for hepatotoxicity due to Herbalife products could be secondary to locally restricted contamination with chemicals such as softeners, preservatives, flavor enhancers, pesticides, or heavy metals either intentionally added during the production process or contained in the unrefined raw herb extracts[24].
To date, Herbalife has refused to provide detailed analyses of their products’ composition and ingredients[25]. This contamination hypothesis could also explain the different patterns of pathology seen on liver biopsy specimens previously observed in patients with hepatotoxicity from Herbalife products as both predominantly cholestatic injury pattern and acute hepatitis pattern have been reported[8-11]. Our patients had findings consistent with acute hepatitis due to drug-induced liver injury on their liver biopsy specimens.
Due to the obesity epidemic, the usage of weight-loss herbal supplements has flourished. Green tea extract is one of the key components in many of the over-the-counter weight-loss herbal supplements. Although significant liver injury induced by herbal supplements taken for weight loss purposes is a rare event, we cannot ignore the fact that there have been multiple reported cases in the medical literature of hepatotoxicity associated with weight-loss herbal supplements including Hydroxycut and Herbalife products. Even though our patients successfully recovered from the adverse reactions, we must bear in mind that the hospitalization and medical care of these patients were associated with significant cost and healthcare resource utilization, while there is no evidence that herbal supplements can help with weight-loss[26]. We must also consider the impact on patients with underlying chronic liver disease, in whom herbal weight loss medications could cause worsening in their synthetic function and even fulminant failure. In May of 2009, the US Food and Drug Administration warned consumers to immediately stop using Hydroxycut products, citing linkage to liver damage in one patient who died due to liver failure[27]. However, Hydroxycut products are currently still available in many parts of the world. Likewise, Herbalife products are widely available globally. Therefore, it is these authors’ view that closer monitoring of patients taking weight-loss herbal supplements as well as tighter regulation from government drug agencies is warranted. Furthermore, our cases once again demonstrated the importance of questioning patients regarding the usage of herbal or nutritional supplements at the time of evaluation.
Supported by Harbor UCLA Medical Center and The Division of Gastroenterology
Peer reviewers: Mary Ko Manibusan, Co-Chair, US Environmental Protection Agency, Office of Pesticide Programs, Health Effects Division - Crystal City, 8136 Viola Street, Springfield, VA 22152, United States; Ferruccio Bonino, Professor, Chief, Scientific Officer, Fondazione IRCCS Ospedale Maggiore Policlinico Mangiagalli e Regina Elena, Via F. Sforza 28, Milano 20122, Italy
S- Editor Zhang HN L- Editor Hughes D E- Editor Liu N

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Copyright©2010 Baishideng Publishing Group Co., Limited. All rights reserved.
Acute liver injury induced by weight-loss herbal supplements
Gary C Chen, Vivek S Ramanathan, David Law, Pauline Funchain, George C Chen, Samuel French, Boris Shlopov, Viktor Eysselein, David Chung, Sonya Reicher and Binh V Pham.
Gary C Chen, Vivek S Ramanathan, David Law, Pauline Funchain, George C Chen, Samuel French, Boris Shlopov, Viktor Eysselein, David Chung, Sonya Reicher, Binh V Pham, Department of Gastroenterology and Pathology, Harbor UCLA Medical Center, Torrance, CA 90509, United States
Author contributions: Chen Gary C, Ramanathan VS, Law D, Funchain P, and Chen George C were involved in direct patient care, data gathering, and case report write ups; French S and Shlopov B are from the department of pathology and interpreted the histology; and Eysselein V, Chung D, Reicher S and Pham BV were the attending gastroenterologists supervising background research and validity.
Correspondence to: Vivek S Ramanathan, MBChB, Department of Medicine, Division of Gastroenterology, Harbor UCLA Medical Center, 1000 W. Carson St, Torrance, CA 90502, United States.
Telephone: +1-917-4340814 Fax: +1-562-9244890
Received August 3, 2010; Revised November 4, 2010; Accepted November 11, 2010;

Slimming at all costs: Herbalife®-induced liver injury

Complementary and alternative medicine (CAM) is experiencing an astonishing boom due to the public’s increasing interest in disease prophylaxis, nutrition, and improvements to health and well-being. A substantial contribution to this development includes nutritional supplements such as vitamins, antioxidants and herbals, formula diets to reduce weight, and poorly defined preparations to “shape the body”. Most individuals who use these products should be considered “customers” rather than “patients” since they have no intention to specifically treat diseases but to improve their health in general. The majority use herbal and food supplements in self medication at considerable personal expense without prior consultation and knowledge of their doctors. A countrywide survey from the U.S. revealed a prevalence between 37.5% and 67% [1] and a steady rise [2] in the use of herbal medicine and nutritional supplements. The sales of these products are enormous; for example, an impressive $33 billion was spent on weight-loss products alone in 1999 [3]. One may welcome this development since it actually reflects the public’s increased awareness of disease prevention and health, even if real benefits from these substances for consumers are minor. However, several problems exist: (1) Reports about adverse reactions, particular liver injury, have accumulated, so, these preparations are not always as harmless as perceived [4]. (2) In most Western countries including the EU and the U.S., nutritional supplements and herbal CAM preparations are exempt from strict licensing regulations routinely imposed on synthetic drugs or medicinal products before releasing them onto the market. CAM preparations are handled like food products for which no pre-marketing approval is required. Liability remains entirely with the company and no proof of safety, let alone efficacy, has to be provided. (3) Increasingly, customers purchase herbals and nutritional supplements from largely anonymous Internet sources without consulting a doctor or a pharmacist. (4) Composition of most products is insufficiently characterized, often unlabelled, highly variable and clear beneficial effects for the consumers do not exist. (5) Companies claim that alleged health advantages would only become visible through long-term and regular use although this is not backed up by supporting clinical evidence. Therefore, the usually high costs of these products stand in utter contrast to their unproven benefits [5], [6]. (6) Often, physicians’ level of knowledge about dietary supplements and herbals, their regulation and potential hazards is vague and their awareness of CAM preparations as a potential source of health damage is low [7]. (7) Products are often presented in a fashion that raises unfounded hopes and expectations which cannot be fulfilled. It has to be emphasized that online information about the products offered constitutes advertisements rather than serious scientific information; this distinction is often difficult to make for most lay customers.
Apart from the lack of evidence for a long-term clinical benefit, herbal combinations taken for weight loss have been recognized as potential causes of liver injury in several case report series demonstrating acute hepatitis following the intake of LipoKinetix [8], preparations containing ephedrin [9], and green tea extracts [10].
In this issue of the Journal, two case report series from Israel and Switzerland for the first time describe incidents of severe liver injury along with the intake of a panel of different Herbalife® products [11], [12]. Herbalife® sells nutritional and herbal supplements for weight control, improvement of nutrition, and “well-being”, and cosmetics online or through independently operating sales agents. Among the 22 cases of liver damage following Herbalife® intake analyzed in the two reports, two patients developed fulminant hepatic failure requiring super urgent liver transplantation which saved one patient’s life while the second died due to postoperative complications. Causality between the intake of Herbalife® products and the evolution of liver injury was carefully assessed by internationally accepted causality scores [13], [14]. In five patients, causality was labelled “certain” by a positive re-challenge reaction and “probable” in additional 13 patients. Other potential causes were ruled out in all patients, although one patient with positivity for HBsAg seemingly developed hepatitis B reactivation and proceeded to fulminant liver failure. Considering the patients in whom symptoms and signs of liver injury recurred following re-administration of Herbalife® products, there appears to be little doubt that these products were the cause. All internationally evaluated scoring systems regard a positive rechallenge as the strongest proof of causality [13], [14], [15]. Although entirely descriptive, the two papers are important and add another, thus far unknown, candidate to the list of products that can cause liver damage.
However, the two reports raise more questions than they answer. Although causality was tested appropriately, it remains entirely speculative what might have been the cause of liver damage in the 22 patients. The patients took between 3 and 17 different Herbalife® products which makes it extremely difficult, if not impossible, to identify the crucial compound(s). Efforts by the authors to retrieve a detailed composition analysis were apparently unsuccessful since the company refused to provide such information. In 2006, the stock market quoted Herbalife® company as having a revenue of $ 3.1 billion; the company’s reluctance to provide detailed analyses of their products’ composition is difficult to understand considering what is at stake should news about associated dangers spread. However, due to this lack of co-operation, attempts should have been made by the investigators to analyze the ingested Herbalife®products for toxins, microbial contamination or to screen affected individuals for possible immunoallergic reactions to the consumed material. While this was not possible in the Swiss series due to retrospective data collection, at least one of the Israeli cases was apparently followed up recently as the relapse was noticed. However, neither the batch taken by these patients nor those taken by the other patients were subjected to a closer analysis, although all patients were contacted personally. Fulminant liver failure due to bacterial toxins was described by Mahler et al. in two cases following the ingestion of reheated pasta sauce contaminated with Bacillus cereus which produces a hepatotoxic toxin [16]. However, such catastrophic incidents usually do not result in larger series of unrelated cases.
Another explanation for Herbalife®-associated liver damage could be a locally restricted contamination with chemicals such as softeners, preservatives, flavour enhancers, pesticides, or heavy metals either intentionally added during the manufacturing process or contained in the unrefined raw products, i.e. herb extracts [17]. This possibility could explain the different patterns of liver injury found in the two series with predominantly cholestatic hepatitis in the Swiss patients and hepatocellular hepatitis in the Israeli subjects. Two unusual patterns of injury were observed in the Swiss series – sinusoidal obstruction syndrome and giant cell hepatitis. These two lesions are typical of intoxication with pyrrolizidine alkaloids and intake of Plantago ovata/Emblica officinalis (Isabgol), respectively, and it cannot be excluded that the consumed Herbalife® products contained either of these compounds. Apart from these considerations, it is well-known that a single drug/substance can produce different patterns of hepatic damage. So, should further cases of Herbalife® hepatotoxicity be detected, clinicians and researchers are urged to retrieve the batch(es) that were consumed by their patients to perform detailed screenings for microbes, their toxins, and chemicals.
It remains speculative why cases of Herbalife® hepatotoxicity were only noticed in Switzerland and Israel, although Herbalife® products are sold in at least 60 countries all over the world. Based on experiences with adverse drug reactions due to synthetic drugs, simple probability should have led to additional incidents of Herbalife®-associated hepatotoxicity. Isolated series of drug-induced liver damage are highly suggestive of either significant underreporting in other countries with a more widespread consumption, or indicate the specific distribution of “spoiled” or contaminated batches. However, as the Swiss authors rightly state, the “threat to the public health” from Herbalife® products is minor and should not be exaggerated when compared with incidence rates of adverse hepatic reactions of other over-the-counter pharmaceuticals such as non-steroidal anti-inflammatory drugs [18].
The two series emphasize the need for caution regarding poorly labelled herbal weight, loss products with questionable benefits and, considering the principle “first, do no harm”, clearly shift the risk-benefit ratio against their use.



The U.S. Food and Drug Administration (FDA) is warning consumers to immediately stop using Hydroxycut products by Iovate Health Sciences Inc., of Oakville, Ontario and distributed by Iovate Health Sciences USA Inc. of Blasdell, N.Y. Some Hydroxycut products are associated with a number of serious liver injuries. Iovate has agreed to recall Hydroxycut products from the market.
Hydroxycut products are dietary supplements that are marketed for weight loss, as fat burners, as energy-enhancers, as low carb diet aids, and for water loss under the Iovate and MuscleTech brand names.
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Serious Health Risks

FDA has received 23 reports of serious health problems ranging from jaundice and elevated liver enzymes, an indicator of potential liver injury, to liver damage requiring liver transplant. One death due to liver failure has been reported to the FDA.
Liver injury, although rare, was reported by patients at the doses of Hydroxycut recommended on the bottle. Symptoms of liver injury include jaundice (yellowing of the skin or whites of the eyes) and brown urine. Other symptoms include nausea, vomiting, light-colored stools, excessive fatigue, weakness, stomach or abdominal pain, itching, and loss of appetite.
Other health problems reported include seizures; cardiovascular disorders; and rhabdomyolysis, a type of muscle damage that can lead to other serious health problems such as kidney failure.
FDA urges consumers to stop using Hydroxycut products in order to avoid any undue risk, says Linda Katz, M.D., interim chief medical officer of FDA's Center for Food Safety and Applied Nutrition. "Adverse events are rare, but exist," Katz says. "Consumers should consult a physician or other health care professional if they are experiencing symptoms possibly associated with these products.
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Recalled Products

The list of products being recalled by Iovate currently includes:
  • Hydroxycut Regular Rapid Release Caplets
  • Hydroxycut Caffeine-Free Rapid Release Caplets
  • Hydroxycut Hardcore Liquid Caplets
  • Hydroxycut Max Liquid Caplets
  • Hydroxycut Regular Drink Packets
  • Hydroxycut Caffeine-Free Drink Packets
  • Hydroxycut Hardcore Drink Packets (Ignition Stix)
  • Hydroxycut Max Drink Packets
  • Hydroxycut Liquid Shots
  • Hydroxycut Hardcore RTDs (Ready-to-Drink)
  • Hydroxycut Max Aqua Shed
  • Hydroxycut 24
  • Hydroxycut Carb Control
  • Hydroxycut Natural
Although FDA has not received reports of serious liver-related adverse reactions for all Hydroxycut products, Iovate has agreed to recall all the products listed above. Hydroxycut Cleanse and Hoodia products are not affected by the recall.
Consumers who have these products are advised to stop using them and to return them to the place of purchase. The agency has not yet determined which ingredients, dosages, or other health-related factors may be associated with risks related to these Hydroxycut products. The products contain a variety of ingredients and herbal extracts.
Health care professionals and consumers are encouraged to report serious adverse events (side effects) or product quality problems with the use of these products to FDA's MedWatch Adverse Event Reporting program online, by regular mail, fax or phone.
Online: Medwatch Reporting
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This article appears on FDA's Consumer Update page, which features the latest on all FDA-regulated products.
Date Posted: May 1, 2009


This article was created by a professional writer and edited by experienced copy editors, both qualified members of the Demand Media Studios community. All articles go through an editorial process that includes subject matter guidelines, plagiarism review, fact-checking, and other steps in an effort to provide reliable information. By an eHow Contributor

Herbalife was founded by Mark Hughes in 1980. Hughes proclaimed that the company's mission was to improve the health of people all around the world. Many dieters rave about the weightloss success they achieve following the Herbalife plan; others are not as enthusiastic about the product and claim harm from its use.

1. Caffeine Overload

Herbalife contains caffeine. Many people who who take Herbalife supplements have claimed to feel restless and nervous, along with experiencing the jitters and anxiety.


Herbalife products, when analyzed, were found to contain high levels of lead. The amounts found in Herbalife products were above what the laws allows and were deemed toxic.


Herbalife products have been liked to hypertension, which can lead to heart failure.

Unsubstantiated Claims

Herbalife's checkered past includes warnings from the FDA for false claims about their products.These artificial claims included helping to treat many diseases, getting rid of tumors, increasing circulation, improving alertness and improving overall health.

Side Effects

Many users of Herbalife have filed lawsuits and complaints about side effects they experienced when using the products. Headaches, constipation, diarrhea, lightheadedness, nausea, and stomach upset are some reported side effects.

Questionable Ingredients

Ephedra, a main ingredient in Herbalife, has been known to cause psychosis, tremors, kidney stones, high blood pressure, sweats, rapid heartbeat, and damage to the heart and other organs. It has been linked to strokes, seizures and death.

Read more: What Are the Dangers of Herbalife? | Herbalife is promoted for weight loss. Its product line involves a complex herbal formula that's also purported to cleanse your body and improve vitality. The diet has a myriad of fans who attribute success in overcoming ev erything from obesity to serious medical conditions to the company's concoctions. However, the U.S. Food and Drug Administration does not back any such claims and even forced the company to recall a training manual that claimed medicinal values, reports "Cincinnati Magazine." If you'd like to give Herbalife a go, check with your doctor first. Also know that Herbalife can have side effects.

Cascara Sagrada Effects

Herbalife contains Cascara sagrada, advises Mary McCarty of "Cincinnati Magazine." This is a laxative that can cause diarrhea. Cascara sagrada can have side other effects such as cramps and abdominal discomfort, notes George T. Grossberg and Barry Fox in "The Essential Herb -Drug-Vitamin Interaction Guide." It also can raise risk of irregular heartbe at if taken with certain medicines such as acebutolol or insulin. Cascara sagrada increases risk for low levels of potassium in your blood, a condition called hypokalemia, when taken with me dicines like cortisone and chlorothiaxide. If you have a gastrointestinal disease, it also can worsen your condition.
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 Senna Effects

The senna leaves in Herbalife can cause vomiting, nausea, flatulence, irregular heartbeat and kidney damage along with cramping and diarrhe a. This herb can lead to hypokalemia as well, especially when combined with Cascara sagrada and/or medicines that have diuretic effects, note Grossberg and Fox. Ingesting senna with drugs such as estradiol can decrease your blood levels of estrogen. Senna can trigger or worsen electrolyte imbalance, dehydration, gastrointestinal problems and heart ailments, note Grossberg and Fox.

Uva Ursi Liver Concerns

Some Herbalife formulations have unknown amounts of uva ursi, says Deborah R. Mitchell, lead author for "The Diet Pill Guide." One chemical in this herb, called hydroquinone, can be toxic to your liver, advises the University of Maryland Medical Center, or UMMC. Thus, you should take products with this herb only for five days at a time, no more than five times a year, advise the experts at UMMC. It also can lead to insomnia, irritability, vomiting and nausea. You should not take products with uva ursi in them if you have high blood pressure, are pregnant, have a kidney or liver ailment, suffer an ulcer or have digestive problems, according to UMMC.


At least one case of acute mania may be attributed to Herbalife, according to "Meyler's Side Effects of Herbal Medicines," by J.K. Aronson. A 39 -year-old man who had no history of mental disturbance developed the symptoms between four and 72 hours of taking Herbalife. He took it for several more days and became paranoid, psychotic and out of control, Aronson reports. His episode culminated with a high-speed car chase by police. He was treated for bipolar disorder and quit taking Herbalife. He remained symptom free three years later, Aronson reports.
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"Meyler's Side Effects of Herbal Medicines;" J.K. Aronson; 2008 Cincinnati Magazine: Diets---The Good, The Fad and The Quirky; Mary McCarty; 1986

"The Essential Herb-Drug-Vitamin Interaction Guide;" George T. Grossberg and Barry Fox; 2007
"The Diet Pill Guide;" Deborah R. Mitchell et al.; 2002

Read more: -are-there-any-bad-side-effects-tousing-herbalife/#ixzz1RCam30iP

Herbalife Side Effects
Certain ingredients in some of the Herbalife products may cause Herbalife side effects for various people. Fortunately the USDA requires that any such warnings be included on the Herbalife product labels. Herbalife aside, you should always inspect the product label for any over the counter weight loss supplement. Here are three ingredients that could possibly cause side effects:
1. Caffeine Some Herbalife products contain caffeine as a metabolism booster. Caffeine can cause nervousness, headaches and higher blood pressure. A typical cup of coffee has about 85mg of caffeine per cup. Per serving, Herbalife teas, tablets, and effervescent products have between 65-75 mg of caffeine per serving. If you are allergic to caffeine you should

avoid the products that include caffeine. Some of these are: N-R-G Tablets and Liftoff energy drink. Check the product labels on other products for the ingredients. 2. Protein and/or Soy Some people are allergic to concentrated protein. Although the body has protein in our cells, the problem occurs when too much protein upsets the balance in the body s ability to process protein. Again, check the product labels for each Herbalife product you are considering. 3. Shellfish According to Herbalife certain products contain shellfish, so if you are allergic to shellfish, you may want to avoid these products: Herbalifeline®, Tri-Shield®, Joint Support.

Risks of Herbalife
Therese Pope is a copywriter and marketing consultant for her own business, Zenful Communications. Her public health nonprofit background, coupled with her writing background, led her to write about the health and wellness industry. Pope was a blogger for and currently writes a variety of SEO Web content. She holds a Bachelor of Arts in journalism from California State University, Chico. By
Therese Pope, eHow Contributor

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Print this article
Herbalife is a natural diet pill supplement. Herbalife sells supplements and shakes that increase energy and raises metabolism. It has been associated with controversy over the years because it used to contain the drug ephedra. Ephedra was taken off the market by the FDA because it was associated with causing heart problems. The following health risks are associated with Herbalife products.

1. Anxiety and Restlessness

Herbalife supplements contain caffeine. Caffeine helps increase metabolism (which helps with weight loss), but caffeine can also cause anxiety and restlessness.

Increased Blood Pressure

Because Herbalife contains caffeine, it can increase blood pressure. When blood pressure (hypertension) increases over an extended period of time, cardiovascular problems such as heart disease and stroke can occur.

Counteraction with Prescription Medication

Because Herbalife contains a wide variety of herbs, it can counteract with prescription medication. People with medical issues who take prescribed medication should consult with their doctor before taking Herbalife.


Herbalife's herbal formula helps boost metabolism to lose weight. However, the caffeine (yerba mate extract) can cause headaches.


Herbalife is not a herbal supplement approved by the Federal Drug Administration (FDA). Herbalife has also been accused of using too much lead in their products, and has recently been involved in a court case because their supplements exceed the normal lead limit. More information about the risks of Herbalife are available at the Resources below.

Read more: Risks of Herbalife | -of-herbalife.html#ixzz1RCbb9qLR

Criticism of the Herbalife Diet Program
By Dr. Kendra Pearsall, N.M.D. with Dr. Chris Traxler, M.D.

Email Review

History and Background Information:
Herbalife is a health supplement MLM (multi-level marketing) company with a weight loss emphasis. It was founded in 1980 by 24 -year-old Mark Hughes. Net sales in 2006 were over $1.9 Billion dollars with over a million distributors worldwide. It was created²by a ninth grade dropout and juvenile delinquent ² who decided to create his own MLM after being a distributor for two other weight loss MLM companies that went out of business. According to a 1985 issue of the Herbalife Journal, Hughes started Herbalife because his own mother was 30 pounds overweight and died (when he was only 19 years old) by overdosing on diet pills and unwise dieting practices. Her death left him with a ³fervent desire to find a product that would enhance and build health while allowing an individual to take weight off sensibly and safely«´ In actuality, the autopsy report shows that Hughes¶ mother died of an overdose of Darvon, a narcotic. Although 5 -foot-6-inches tall, she was a mere 105 pounds at death²hardly 30 pounds overweight. There are reports that Hughes traveled to China to study herbal medicine although he had no formal medical or nutrition training. According to the Herbalife literature: During [Hughes] search, he had met Richard Marconi, PhD, with whom he shared his dream «. After a lot of research and testing, Herbalife Slim and Trim was born. Actually the truth is only after he met Richard Marconi and formed the company did Marconi sign up for a mail order PhD program to add more credibility to the company. The many statements Herbalife representatives have made about extensive testing and research have been shown to be false in later court trials. Hughes started the company by selling Herbalife products out of the trunk of

his car because he couldn¶t afford a storefront. According to one former Herbalife employee, Hughes was able to make the company immensely successful because of his incredible charisma; he was loved and admired by his distributors. He led hundreds of sales rallies -- resembling religious evangelical gatherings -- drawing people both to the products and the prospect of getting rich selling them. His pitches are still broadcast on Herbalife's Web site.

Troubled Past For Herbalife
In 1982, the FDA sent Herbalife a Notice of Adverse Findings, which reb uked Herbalife for labeling claims that their products were effective for treating many diseases, dissolving and removing tumors, rejuvenating, increasing circulation, and producing mental alertness.

Safety Concerns
A 1984, FDA Talk Paper notes that the FDA had received many complaints about side effects that had occurred during the use of Herbalife products and had stopped when use of the products was stopped. Company literature given to Herbalife distributors at the time stated that ³up to 25% of product users will have adverse effects´ but claims that this is evidence of the body's improving itself. Several suits were filed by people who alleged that the products had harmed them. Some of these suits were settled out of court with substantial payment, but the amounts have not been disclosed, and the case records are sealed. The hearing also brought to light a study done by Herbalife of 428 users of its products. About 40% had experienced headache, constipation, diarrhea, nausea, lighthea dedness, palpitations, and/or other transient symptoms that might be attributable to Herbalife products. The occurrence of side effects came as no surprise, because several ingredients in Herbalife products were potent laxatives and one product (N.R.G.) contained guarana, which is high in caffeine.

Research and Testing
By 1985, Senate hearings grilled Hughes about the "research and testing" done prior to marketing Herbalife's products. Hughes said, "We have a lot of scientific data on the herbs," but it w as ascertained that no actual testing of Herbalife products had taken place. Marconi told a CNN interviewer, "We employed hundreds « even thousands of PhDs in the research program for our products." But when asked who they were, he replied, "Why, the research papers that are published and printed that we have access to on our computer." In March 1985, the California Attorney General had charged Herbalife with: 1) Violating California's consumer protection laws. 2) Making illegal claims in the company handbook that various herbal ingredients were effective against more than 70 diseases and conditions. 3) The suit also charged that Herbalife had been operating an illegal pyramid scheme. The case was settled in 1986 when Hughes and the company agreed to pay $850,000 and to abide by a long list of court -ordered restrictions on claims and marketing practices.

Questionable Ingredients
Concern about the side effects of Herbalife weight loss products has grown, however, after the FDA attributed a 1998 cardiac ar rest suffered by a 28- yearold woman to a Herbalife ephedrine product, Original Green. Ephedrine, a chemical cousin of amphetamines that increases blood pressure and heart rate, has been linked by the FDA to hundreds of adverse reactions and dozens of deaths. Ephedrine, (also known as Ephedra, Ma Huang) was a key ingredient that made the Herbalife products so successful for weight loss. Ephedrine is essentially speed and will shut off your appetite completely ²allowing you to subsist on one meal a day. But it shuts down your appetite at a price:

Possible Side Effects of Ephedra
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nausea headache; dizziness irritation of the stomach; diarrhea anxiety; psychosis kidney stones tremors dry mouth irregular or rapid heart rhythms; heart damage high blood pressure restlessness; nervousness; sleeping problems decreased appetite flushing; sweating increased urination


What You Don’t Know About 

Supplements Can Kill You

There are two comments bound to make any credible herbalist cringe. One is "It can't hurt me, it's all natural," and the other is "herbs don't have any side effects or interactions." Both are wrong. They can hurt you and they do have side effects and interactions.
Dangerous Herbs: Two good examples in this category are Ephedra and Blue Cohosh. Ephedra has often been used in weight loss products. It was once banned but seems to now be in some sort of grey area. The problem is that it could kill you. The substance in it is chemically similar to epinephrine, and it could cause a heart attack, amongst other things.

Blue cohosh is sometimes recommended to speed childbirth. The good news is that it can do just that. The bad news is that both mother and child could die before the baby is even born. Infants have been born having heart attacks because their mother took blue cohosh.

Cautionary Herbs: Some herbs may be effective, but the number of side effects, interactions or preparation methods makes herbalists nervous unless properly prepared. Cherry bark is great for stopping a cough, but it isn't something for those who don't know how to prepare it to work with. The principle that helps stop the cough is cyanide, and too much of that will kill you.

Licorice is another good example. The problem here are the side effects and interactions. The root is high in sugar, so it could cause problems in diabetics. It raises blood pressure, so it could cause problems for those with high blood pressure or heart disease. In fact, it can cause heart rhythm problems in healthy people.
GRAS: This acronym stands for "generally recognized as safe." While these herbs do have side effects and interactions, most people can take them safely. Chamomile, garlic, lemon balm and so forth are all on this list.

There are three ways herbs can have a major effect on your body. Knowing the herb and what these terms mean may help you make the right decision.

Interaction: This problem happens when two things are combined that react to each other. If you've ever done the "volcano" experiment, you've seen one outside your body. If you mix vinegar and baking soda, it will foam up. Some herbs do that inside the body, both with other herbs and with medications. While this is all right on occasion, most of the time interactions are not considered good things.

Side Effects: The main action of chamomile is to help calm a person down. One of the side effects is it makes that person sleepy. Another is that it could cause uterine contractions. These side effects can be a problem if you're driving somewhere or you're pregnant. That's what a side effect is; something other than the main reason you're taking the supplement.

Medical Conditions: Conditions such as diabetes, heart disease and immune function diseases can all react negatively to certain herbs. I've already mentioned licorice, which covers the first two. When it comes to the immune system, another popular herb is a problem. It is not advised to take Echinacea if you have any problem that affects that system.

Choosing the right supplement is not like picking out a new pair of shoes. Talk to your doctor, your pharmacist and if possible a qualified herbal practitioner. We may be able to help you find a supplement that is right for you and doesn't do you more harm than good.


Saw Palmetto and Liver Toxicity. How Over-The-Counter Herbal Supplements Can Kill You.

Saw palmetto comes from a palm-like plant that grows in the southeast United States. The berries of this plant are used to make the capsule form of saw palmetto.

Saw palmetto has been used to treat symptoms of enlarged prostate (benign prostatic hypertrophy or BPH). Saw palmetto is also popular as an herbal remedy for a type of hair loss and baldness called androgenic alopecia, or male- and female-pattern baldness. This type of hair loss is typically the greatest at the top of the head or around the temples. Although it is still not know exactly how it works, it’s believed that it may block an enzyme (5-alpha-reductase) from allowing the hormone testosterone from being converted to another hormone, dihydrotestosterone. Dihydrotestosterone is considered a key contributing factor to the onset and progression of androgenic alopecia and benign prostatic hyperplasia.
Saw palmetto has not been evaluated by the FDA for safety, effectiveness, or purity. All potential risks and/or advantages of saw palmetto may not be known. Additionally, there are no regulated manufacturing standards in place for these compounds.
The case below is an example of what a liver with saw palmetto toxicity would look like. Before the liver is sliced, you can appreciate how abnormal it looks. Grossly it is just gnarly. It’s enlarged, green-orange/brown and extremely nodular. Compare that to the normal liver photo seen directly below it…

The outer surface of the liver is so nodular it almost looked cirrhotic, until it was sliced.

The orange/brown areas of the liver are grossly consistent with confluent to almost sub-massive hepatic necrosis. Microscopically these areas would show dead hepatocytes (liver cells). These findings can be seen in fulminant hepatic necrosis with autoimmune hepatitis, hepatitis B virus and drug toxicity. The liver grossly looks nodular because the areas of necrosis (orange/brown)areas are dead and collapsed, so the live (green) areas are raised giving a nodular appearance. It is not cirrhotic. Laboratory tests could rule out autoimmune hepatitis and viral hepatitis.
The final diagnosis: Confluent to almost sub-massive hepatic necrosis due to acute drug (saw palmetto) toxicity.
According to the National Institutes of Health, several cases of liver problems have been reported from saw palmetto use. A report of possible acute liver toxicity from saw palmetto was published in “British Journal of Clinical Pharmacology” in 2010. After the patient discontinued saw palmetto, all symptoms disappeared within a few weeks. Unfortunately, in some cases, the liver can be damaged beyond repair and this diagnosis is made at autopsy.

Herbalife Side Effects
Some people experience unpleasant side effects when using various Herbalife products. These are described and addressed in this article for your safety and well-being.

If you experience bloating, try changing the portion size to reduce this feeling. Enjoy healthy snacks during the day and smaller meals to assist your digestion. If you are using the shake mix as a meal replacement you may want to reduce the portion size or frequency. 
Dry Mouth:

Some people report that their mouth is dry after black or fruit tea. Detox products often produce thirst so you can try increasing your intake of water. Dryness from using the shakes can be caused by acid reflux since it contains guar gum and psyllium husk. These have expanding properties, which can cause reflux. Guar bean is high in protein and oil and guar gum is used worldwide in many beverages, foods and supplements. In significant quantities, guar gum dehydrates the body and can cause some serious side effects. However, it is regulated by the FDA who only permits extremely small quantities of it in food. Guar gum in the shake mix is used to emulsify or bind the particles and has been determined to be of insignificant quantities.
Heart Palpitations:

Palpitations may be from caffeine sensitivity. The tea does have caffeine in it so you could either stop using the tea or eventually you will get used to caffeine and the palpations should recede. The shake mix does not contain any caffeine.
In the nineties it was found that Ephedra caused increased heart rate and Herbalife discontinued using Ephedra in any of its products.
Upset Stomach, Headache and Fevers:

 In the first few days, many years of accumulated toxins and waste in the body begin to be expelled. Diarrhea, headaches, fever or nausea can arise.
These are temporary symptoms and will subside whether you continue the diet or not. The discomfort is not very common but happens to some people. Once you are detoxified you should feel great however. The body has toxins or free radicals surrounded by fat molecules, and when burning these fat molecules, the toxins are released into the bloodstream for elimination. They circulate through the body and are filtered out by the kidneys and liver. This can take up to 2 weeks. Areas where toxins and pollutants are expelled from the body can display reactions. You can first use a detoxification program to cleanse your system before starting the weight loss program if you wish.

Unpleasant-Smelling Urine or Perspiration:
 This is another possible reaction to the body cleansing that is not caused by the products, but the waste you are cleaning out. The products are working just as they should.
Allergic Reaction and Blocked Sinuses:
 People who are very allergic to fish need to know that some Herbalife products contain fish oil. See a medical specialist to determine if this is an allergic reaction. Sinuses are especially sensitive because they are soft tissue. Sinus irritations should clear in 1 to 3 weeks but if they get worse, discontinue using the product and consult a medical professional.
Beware of nutrient deficiency when losing weight. The Herbalife ShapeWorks program recommends that along with the 2 shakes and one healthy meal, you should add the Multivitamins and Cell Activator to ensure that you are getting enough nutrition. Cell Activator helps increase your nutrient absorption from food.

 Caffeine in green tea is not the same as in coffee. It is slower-acting and has a calmer quality. But if you feel too stimulated try half a cup instead of a whole cup for a while.
Swollen Legs:

 This might indicate an allergic reaction to an ingredient in the Herbalife products. Please show your doctor the product labels and ask his advice. It would be best to discontinue using the product until you know what the cause of your swelling is.
Stomach Acidity:

If you are using Cell-U-Loss, try discontinuing it and see if that reduces your symptoms. If so, then Cell-U-Loss is not for you. If acidity persists when you are not taking it, there is some other cause. Cell-U-Loss contains 3 ingredients which may be causing the acidity: Apple Cider Vinegar, Vitamin C and Iron. It also contains herbs that have diuretic properties such as couch grass and corn silk extract.
Total Control (the metabolism booster) carries a warning to not be used by the pregnant, lactating (or those that want to get pregnant). Rapid weight loss and stimulants during breastfeeding can release too many toxins into your blood stream and thus into your milk. This can cause a decrease in your milk supply and be unhealthy for your baby. Avoid the stimulants in Total Control and the Herbal Tea, which contain caffeine. Herbalife products have nutrition labels that show warnings to guide women who are pregnant, nursing or who may become pregnant.

These are the most commonly reported side-effects that happen when the body is de-toxifying. Redness, blotchy skin and irritation can arise. Your skin being the largest organ, has the most cells to repair and also discharges toxins. It takes about 2 weeks to cleanse the blood stream and during this time the departing toxins can be irritating. Exercise produces sweat and will release toxins that can irritate the skin. Herbal Aloe Soothing Gel can provide symptomatic relief.

Hair Loss or Breakage:
 Formula 1 Nutritional Shake Mix has been shown to improve skin, hair and nail growth. If you experience hair loss early in your weight loss program, this is because damaged cells are being repaired or replaced. When beginning a weight loss program, your body will target the most damaged cells. Hair usually has the oldest cells and is thus the first target for renewal. Hair soon becomes healthier than before so you need not worry about this.
General Detoxing Effects:
It is very well known that at the beginning of a diet or fast there may be some adverse side effects. These usually subside within a few weeks however. If you detoxify for a few days using plain water, fruit or vegetables you will also experience some side effects. When we have better nutrition, or when toxic substances such as coffee, tea, chocolate, tobacco, salt, and pepper are discontinued, amazing changes take place. Our bodies discard the lower grade materials and tissues to make room for newer, healthier ones.
Weight Gain:

 An ideal weight-loss rate is between 3 and 5 pounds per week. If you lose weight gradually and are getting proper nutrition, it will stay off. Moderate exercise like walking is necessary to get the fat burning process going. Adequate hydration (drinking water regularly) is essential to flush the toxins.
Do not try to stop any Herbalife side effects by taking drugs. Either let the healing take its natural course or stop using the product if you experience an allergic reaction.