A popular hair growth supplement linked to liver failure
Key Takeaways
Industry Buzz
"Just a warning out there if you’re on this type of supplement. I’m not just calling out Nutrafol. There are multiple other competitor brands that have this issue as well. It’s because of the high levels of vitamins and supplements in these combinations—many people are taking other vitamins in combination or people may have liver issues that they may not know of." — Amy Shah, MD
Doctors on social media are talking about a case study that highlights a concerning instance of drug-induced liver injury (DILI) associated with Nutrafol, a popular hair growth supplement.
"Just a warning out there if you’re on this type of supplement," Amy Shah, MD, writes in an Instagram caption. "It’s because of the high levels of vitamins and supplements in these combinations—many people are taking other vitamins in combination, or people may have liver issues that they may not know of."
This report underscores the importance of vigilance when recommending non-FDA-approved supplements to patients.
Case overview
Published in The American Journal of Gastroenterology, a 26-year-old woman with a history of obesity presented with jaundice and significantly elevated liver enzymes: total bilirubin of 22, AST 1247, ALT 1318, and alkaline phosphatase 122. []
Her medical history was unremarkable, and she denied significant alcohol use or hepatotoxic medication intake. Notably, she had started using Nutrafol five months prior, following a dermatologist's recommendation.
Laboratory tests ruled out viral hepatitis, autoimmune disorders, and other common causes of liver injury.
Imaging studies, including CT abdomen, abdominal ultrasound with Doppler, and MRCP, showed no primary hepatic, biliary, or vascular pathologies.
A liver biopsy revealed moderate portal inflammation with marked necroinflammatory injury, parenchymal collapse, and cholestasis.
Upon discontinuation of Nutrafol, the patient's liver enzymes and bilirubin levels gradually improved, suggesting a temporal relationship between the supplement and the liver injury.
Potential hepatotoxic ingredients in Nutrafol
Nutrafol contains several herbal ingredients that have been associated with hepatotoxicity []:
Turmeric: Grade B evidence for hepatotoxic potential
Ashwagandha and horsetail: Grade C
Saw palmetto: Grade D
Kelp minerals and resveratrol: Grade E.
These ingredients, while marketed as natural, can have potent effects on the liver and may contribute to DILI in susceptible individuals.
Related: Dangerous duos: 5 supplement combos to avoid