Surge in self-medication leading to liver damage during Covid, says Dr Abby Philips – India Today

Increased use of Ayurvedic, naturopathy, and other such alternative medicines is reportedly leading to liver damage and many other complications during the Covid-19 pandemic, as per Dr Abby Philips of The Liver Institute, Center of Excellence in GI Sciences, Rajagiri Hospital, Aluva.

Dr Abby Philips, who goes by TheLiverDoc on Twitter, said that lack of knowledge and misconceptions about naturopathy and over-reliance on Ayurveda is leading to many such problems, especially triggered during the pandemic.

In an interview with India Today, Dr Philips alleged that there have been cases of liver damage related to the usage of Giloy, a common herb extensively used as Covid prevention medicine.

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Here is an excerpt of the interview with Dr Abby Philips:

Q. How has excessive usage of Ayurvedic and naturopathy medication affected people's health during the pandemic?

Much of the claimed benefits of Ayurvedic or other alternative practices for prevention and treatment of Covid-19 have been baseless and mostly extrapolated from weak foundational studies in the lab setting, none conclusively shown of use in human trials. Extraordinary claims require extraordinary evidence. Prevention of infection using herbs or herbal mixtures was rampant during the Covid-19 pandemic. Since these are not regulated like actual drugs and medicines, people were able to get them over the counter and use it for themselves. Even though none of these measures improved responses to Covid-19, some of these adversely affected our citizens.

For example, the rampant use of Giloy as prevention for Covid-19 was associated with severe liver injury leading to death and even liver transplantation in some of the affected. This is just the tip of the iceberg as many such cases due to the use of herbal supplements and multi-herbal products go undiagnosed, and hence the true incidence of this public health issue is not known at this time.

The data on Giloy-liver injury has been published from multiple centers in India and also in the form of a multicenter nationwide study recently.

Similarly, cases of Siddha medicine Kabasura Kudineer induced liver injury and heavy metal toxicities due to Ayurvedic herbal supplements were also well documented during the pandemic.

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Almost all of the published evidence on Ayurvedic herbals causing harm in the patient and the general population are not due to excessive use, but associated with prescribed suggested use. So, concluding that herbal-related side effects happen only with excessive use is wrong.

Q. About cases that are possibly related to over usage of ayurvedic and naturopathy.

We see up to three new cases of herbal liver injury in our outpatient department on a weekly basis, which drastically increased during the Covid-19 pandemic.

The common herbal liver injury cases that we see include Giloy, ashwagandha, turmeric, green-tea extract, gymnema (gurmar or madhunashini), and most of the time - due to multi-herbal drugs and multiple herbal supplements intake by a patient for a host of conditions such as diabetes, gas trouble, high blood pressure, kidney stones or gall bladder stones and fatty liver. In fact, none of the Ayurvedic herbals have been shown to be of use in any of these conditions.

The cases present with either acute hepatitis where there is just an increase in liver enzymes with or without jaundice, acute liver failure where acute hepatitis leads to liver failure requiring a transplant, or acute chronic liver failure where a stable chronic liver disease patient suddenly worsens and develops multiple organ failure after the herbal liver injury.

None of these are due to over usage - these patients use these herbal products within prescribed limits.

Q. What kind of side effects does Giloy have if consumed excessively?

Giloy can cause an autoimmune-like liver injury that can lead to liver failure requiring liver transplantation in a small group of affected patients. I must emphasize that it is NOT due to overuse or excessive use, but Giloy can cause severe liver injury when used in the prescribed doses also. This is called idiosyncratic liver injury where the liver injury is not dependent on the dose or frequency of the drug or supplement.

Almost all of the liver injury cases identified during the Covid-19 pandemic and also published in medical literature were due to normal, prescribed consumption of Giloy. Giloy has been known to modulate the immune system in such a way that it can lead to an autoimmune attack on the liver leading to severe hepatitis and liver failure.

Giloy must not be consumed by persons with autoimmune disorders and also by those in whom a diagnosed condition associated with autoimmunity, such as diabetes mellitus, hypothyroidism, lupus etc is already known.

Nonetheless, ideally, Giloy must not be consumed at all for any disease prevention or treatment, because strong evidence for clinical benefits with its consumption is lacking in current literature in the human population as studies are mostly done in lab settings, in cell cultures or fruit flies.

Q. What should be the Health Ministry's responsibility over excessive use of ayurvedic medicines?

The Health Ministry along with the Ayush Ministry must bring out joint statements with respect to Ayurvedic medications, for improving public health. This means that together, they must review current evidence of benefits and adverse events of specific herbal/alternative drugs or drug combinations and must inform the public with straightforward facts so that they (the public) and treating physicians can make an informed decision about whether they want to opt for such specific alternative treatment.

The ministry must also mention that it is not excessive use, but also prescribed and suggested doses that can lead to adverse events in the consumer. Who can develop organ damage and what are the safe limits of use of a particular herb are not usually studied with most of the supplements available in the market - because the required toxicity studies in phased trials have not been conducted. These facts must be known to the public.

Q. Any suggestions on Ayurveda, homeopathy, naturopathy, Unani, and another such alternative medicine usage by Covid patients?

Ayurveda, naturopathy, Unani, and Siddha have absolutely no role in the prevention or management of Covid-19. Any evidence to claim that they are useful is flimsy and weak. There are no human clinical trials that are of ideal quality and that have been replicated by several research groups that allow us to prescribe Ayurveda, siddha, or Unani as a preventive or therapeutic modality for Covid-19. This is a plain simple fact and the truth. So, opting for such alternative treatments is not without risks and is definitely without any known benefits.

Now, regarding homeopathy, it is well known that homeopathy does not work for any disease condition and is currently regulated to oblivion by many scientifically progressive nations worldwide. Only in India, the blind promotion of a non-science, quackery-based Homeopathy is taken forward. The best, unknown aspect of Homeopathy for Covid-19 is that Homeopaths themselves have studied Arsenicum album 30C, the Homeopathic remedy peddled by the Ayush Ministry for Covid-19 prevention, and found that Arsenicum Album 30C is absolutely useless for the prevention of Covid-19.

(Dr Abby Philips is a senior physician-scientist in Hepatology, The Liver Institute, Rajagiri Hospital, Kerala. He is also a faculty member of the Guidelines Committee on Drug-Induced Liver Injury of the Asia-Pacific Association for Study of Liver (APASL) and Clinical Advisor and Doctoral Advisory Committee Member Department of Cell and Tissue Culture Sree Chitra Tirunal Institute for Medical Sciences & Technology (Government of India). )

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Surge in self-medication leading to liver damage during Covid, says Dr Abby Philips - India Today