The case of fulminant hepatitis that caused the death of nurse Edmara Silva de Abreu, 42, made a new warning of the danger arising from the consumption of products without medical supervision.
Abreu had used “herbal slimming” capsules that contained green tea, carqueja and mata verde. These substances are considered hepatotoxic, that is, they can cause liver damage and trigger serious health problems, such as hepatitis, an inflammation in the organ with several causes.
Liliana Ducatti, the doctor who attended the nurse, says that the lack of regulation of products like these and the excessive use by the population are factors that contribute to the occurrence of these problems.
“It’s one thing for us to take [esses chás] for pleasure, reasonable doses, conscious and balanced consumption. It’s another thing to take huge doses for an effect that doesn’t exist, which would be to lose weight,” he says.
Unfortunately, cases like these are not rare, says Giovanni Silva, a hepatologist and president of the SBH (Brazilian Society of Hepatology). “There is a concept, in the lay population, that a natural product is healthy, but this is extremely wrong. We have numerous natural substances […] that are toxic.”
The doctor explains that fulminant hepatitis — also called acute liver failure — is one of the ways that acute inflammation of the liver can be presented in a patient.
“One of the manifestations of acute hepatitis is its fulminant course, that is, [quando se dá a] progression to acute liver failure. if [o fÃgado] is not transplanted, the person can quickly progress to death”, he says.
Unlike the chronic form, which is inflammation in an already weakened liver that loses its functions over time, acute hepatitis happens when the organ suffers wear and tear without being linked to another disease.
“[A forma aguda da hepatite] may be asymptomatic, the diagnosis being made only by changes in the blood test. At [formas] symptoms are marked mainly because the person turns yellow [icterÃcia] by an increase in bilirubin in the blood. It also has coke-colored urine and eventually white stools,” she says.
The development of acute hepatitis can occur in two ways: dose-dependent or hypersensitivity. The first case is when a person uses a product that can cause liver problems in large doses.
“You need a higher dose to attack the liver cell, which is the hepatocyte. This hepatocyte inflames, necroses and dies. If this cell death is too extensive in the liver, it can lead to acute liver failure.”
Silva explains that there are many substances that can result in cases of fulminant hepatitis through dose-dependent, such as herbs similar to those used by the nurse who died or even medications.
The problem with natural products is that they do not undergo clinical studies and there is also no regularization by health agencies, such as Anvisa (National Health Surveillance Agency). This makes it more difficult to control them, preventing an adequate measurement of the active principles that compose them.
Ducatti also points out that taking exaggerated doses — as happened with Abreu — causes liver complications. “There are people who drink, for example, two liters of horsetail tea [erva hepatóxica] per day […] and that also ceases to be a safe amount.”
The other possibility of acute hepatitis occurring is when the individual is hypersensitive to the substance that inflames the liver. “There are medicines that are harmful regardless of the dose, unfortunately due to a reaction of host sensitivity”, explains Liliana Mendes, a hepatologist at SÃrio-Libanês and SBH.
According to the doctor, it is difficult to say in relation to which substance a person has or does not have hypersensitivity. This gets even more complicated with unregulated products as it is not possible to really infer what their properties are. She mentions cases where these herbs are mixed with heavy metals or pain relievers, to name just a few examples.
Treatment for fulminant hepatitis primarily involves stopping the substance that is causing the problem. Complications in the liver are treated and, if the situation does not improve, organ transplantation is necessary. If you really need the transplant, the patient undergoes tests to determine the level of wear and tear on the liver and may have priority on the waiting list to receive the organ.
The search for beauty
As in the case of Abreu, many of the patients that Mendes sees with fulminant hepatitis used products without control of the composition in the search for weight loss, muscle mass gain or rejuvenation.
“These are people who seek health and are being victims of this criminal market. [Abreu] was another victim of the many that pass through our offices every day”, says the hepatologist.
Mendes cites a case of a recent patient who was diagnosed with cirrhosis. She took products to increase muscle mass and also herbs that contained hepatotoxic substances. However, the discovery of the complications came too late, as “she didn’t discover the problem as long as it was reversible”.
For the hepatologist, the main point is that, in addition to proper medical follow-up, people need to understand that body changes, such as weight loss, do not happen in a miraculous way. “Losing weight requires a lifestyle change,” she concludes.
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