Acute Liver Injury Likely Induced by Alpha Lipoic Acid Contained in Dietary Supplement

The rise in use of herbal and dietary supplements, which are regulated as food rather than as drugs by the Food and Drug Association, poses the risk of unknown and potentially severe side effects. We describe the case of acute liver injury, characterized by significant elevation in AST and ALT, likely induced by the consumption of an over-the-counter supplement containing alpha lipoic acid (ALA). Our patient trusted in a “natural” alternative to Western medicine for management of neuropathy, which was ultimately detrimental to her liver. An immediate and sustained improvement in liver enzyme levels was noted with discontinuation of the patient's daily supplements. Multiple studies have demonstrated the hepato-protective effects of ALA, however data on its adverse effects is limited and not readily available. This is the case for most over-the-counter dietary and herbal supplements available to consumers. In fact, certain animal studies have reported that in high doses, ALA can have negative effects on the liver. While safety and efficacy trials are limited and lag behind the industry’s growth, case reports are instrumental in sharing such information.