“WHO DOES HE THINK HE IS?”
Madol was also developed by Syntex, a manufacturer that carried out promising animal tests on it in the sixties. Upon discontinuation of the oral aloe preparations, liver enzymes returned to normal level. The attack raises two important questions for society. Herbs and healthy livers. Slimming at all costs: The company resumed hitting its numbers in the first quarter of
If doctors come across healthy athletes with an abnormal liver, the researchers write, then they should ask whether the athletes are using potentially 'dangerous' supplements like whey protein and creatine. We agree with the opinion of a blogger — who by the way also works at Gaspari Nutrition — at bodybuilding. But these reports are probably the result of silent use of forbidden substances — and in high quantities.
For example, there was the bodybuilder who said he had developed gyno from using Tribulus terrestris supplements. A preparation made by Natterman, which supposedly protects the liver and which chemical athletes are using more and more often: Greek researchers refer to it in their study as compound N. The researchers, at Thessaly University, set up an experiment to determine whether compound N really works.
After a bit of surfing we worked out that Compound N is Essentiale forte. A packet contains a couple of dozen capsules, each of which contains mg of polyene phosphatidylcholine.
This is choline-phosphoric acid with two unsaturated fatty acids attached, usually linoleic acid. It probably resembles the phosphatidylcholine found in soya. In addition, each capsule contains 6 mg of vitamin B1, 6 mg of vitamin B2, 6 mg of vitamin B6, 6 mcg of vitamin B12, 30 mg of nicotinamide and 6 mg of vitamin E. The Greeks, who by the way have also done research on the psychological effects of anabolic steroids, did an experiment with three hundred and twenty athletes.
Half of them, one hundred and sixty athletes, used steroids. Of these chemical athletes, the researchers gave forty Essentiale forte: All of the chemical athletes took steroids and the researchers monitored them for eight weeks. The list below gives you an idea of what the Greek bodybuilders were using. Yes, the list puzzled us too. And where are the 'new' designer steroids?
Surely athletes in Greece use products like 1-Test and Madol too? The more enzymes in the blood, the harder a time the liver is having. The figure below shows what happened to the liver enzyme concentrations. They suspect that the mixture strengthens the membranes of the liver cells. The livers of steroids users have to work hard to break down all the extra substances they are subjected to. The liver gets fattier because the liver cells are no longer burning fat well [beta-oxidation — Ed.
The supplement helps the liver cells to perform these functions. Reading between the lines you can also see that the Greeks had trouble getting their study published. More damaged livers from superdrol and madol. Liver specialists at the Henry Ford Hospital in Detroit have reported another three cases of bodybuilders who developed liver damage as a result of using designer supplements.
The Superdrol user was He was nauseous, had stopped eating, had jaundice and itched all over. When the symptoms had got worse after two weeks, the doctors gave him prednisone. The anti-inflammatory worked and after another six weeks, he'd made a pretty good recovery. Superdrol is a steroid whose structure and synthesis resemble those of oxymetholone. It was also developed and tested in the late fifties by the makers of oxymetholone, the American pharmaceutical company Syntex.
Although superdrol [see structural formula below] looked like a promising anabolic steroid in animal tests, in subsequent tests potential side effects showed up.
The effects of this move are clearly seen in the medical journals. In doctors in Phoenix, Arizona published an article on the case of bodybuilder who became fatally ill after using superdrol. What patient 2 used was not clear, but it contained at least DHEA. Of the three men referred to in the study, number 2 got off the most lightly.
He recovered spontaneously a couple of weeks after he had stopped using the supplement. Patient 3 used M-Test 2, a designer supplement containing the steroid madol. Madol was also developed by Syntex, a manufacturer that carried out promising animal tests on it in the sixties.
Not much is known about the side-effects of madol. It is not carcinogenic, say German researchers. But they did discover that it enlarged the heart muscle in animal tests. The enlargement itself was not dangerous, but the researchers were not entirely convinced.
In the bodybuilding circuit however there are few stories around of users who have developed liver problems as a result of using madol. The sick madol user had to be given prednisone in the end, after which he recovered. The doctors did not test the preparation the patient had used. And we wonder quite honestly if it only contained madol. According to the study, the bodybuilder became ill after he had taken 57 capsules over a period of a few weeks.
That would be impossible with. The Canadian government has issued warnings about these. Maybe something went wrong during the production of M-Test 2. Or perhaps the doctors got it wrong that Patient 3 used the BMF product. The doctors also read a couple of articles written by colleagues and summarized the information they found. This resulted in the table you see here below. Liver specialists should get extra training on designer supplements that contain oral anabolic steroids, the article concludes.
Published online November Abstract 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. Hydroxycut, Herbalife, Hepatotoxicity, Herbal, 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 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 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.
Given these findings, patient was admitted to the hospital for a higher level of care. 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 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.
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 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.
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. 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. 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.
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. 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.
The patient was treated supportively with fluids and nutrition. The only laboratory value to increase was the patient's serum TB, which was at 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.
Case 3 A 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 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. An ultrasound showed borderline hepatomegaly of cm. 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.
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. 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 alphaantitripsin 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. 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.
Rechallenging patients with the same product led to hepatotoxicity, confirming the role of C. However, there have been cases of liver failure caused by green tea extract C. 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. The exact mechanism of hepatotoxicity induced by Hydroxycut is unknown.
However, as this product contains green tea extract C. 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. 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 ].
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 , 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. Furthermore, our cases once again demonstrated the importance of questioning patients regarding the usage of herbal or nutritional supplements at the time of evaluation.
Sforza 28, Milano , Italy. Recent trends in use of herbal and other natural products. Two patients with acute liver injury associated with use of the herbal weight-loss supplement hydroxycut. Acute liver injury associated with the herbal supplement hydroxycut in a soldier deployed to Iraq.
Shim M, Saab S. Severe hepatotoxicity due to Hydroxycut: Severe hepatotoxicity following ingestion of Herbalife nutritional supplements contaminated with Bacillus subtilis.
Association between consumption of Herbalife nutritional supplements and acute hepatotoxicity. Herbal does not mean innocuous: Hepatotoxicity associated with the consumption of herbal slimming products. Med Clin Barc ; Hepatotoxicity associated with supplements containing Chinese green tea Camellia sinensis Ann Intern Med.
Fulminant hepatitis during self-medication with hydroalcoholic extract of green tea. Eur J Gastroenterol Hepatol. Green tea extracts and acute liver failure: Bjornsson E, Olsson R. Serious adverse liver reactions associated with herbal weight-loss supplements.
Acute liver failure induced by green tea extracts: Acute hepatitis due to Exolise, a Camellia sinensis dried ethanolic extract [letter] Med Clin Barc ; Acute hepatitis associated with Camellia thea and Orthosiphon stamineus ingestion [letter] Gastroenterol Hepatol. Hepatotoxicity associated with green tea extracts [electronic letter]. Toxicity of green tea extracts and their constituents in rat hepatocytes in primary culture.
Bacillus cereus and other Bacillus species. Bacillus subtilis as a cause of cholangitis in polycystic kidney and liver disease. N Engl J Med. Slimming at all costs: From Wikipedia, the free encyclopedia. This article may lend undue weight to certain ideas, incidents, or controversies.
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Archived from the original on June 17, Retrieved 2 February Archived from the original on 3 December Retrieved 26 Apr Ten cases of severe hepatotoxicity associated with dietary supplements from Herbalife products". Esther; Duque, Jose M. Pharmacoepidemiology and Drug Safety. World Journal of Hepatology. Retrieved 31 July Archived from the original PDF on Evaluation of cases with positive reexposure tests".
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Perhaps the best thumbnail précis of this saga was provided by hedge fund manager John Hempton, who runs Bronte Capital, in what was actually a prognostication. Someone is going to lose big. And the victor will be so bloodied that the word victory will sound hollow. Johnson is the immovable object. Johnson, who headed Walt Disney Co. In July, Johnson, now 61, completed his third Tour TransAlp, the legendarily grueling, seven-day, mile stage race through the Alps during which cyclists traverse ascents totaling more than 60, feet.
That business took off, and he rode it up the ranks until he was heading the international operations of the whole company. Along comes a guy with half-facts and half-truths and a jaded point of view and starts not just shorting your stock but trying to totally demonize me and demolish the company.
Who the hell does he think he is? Six-foot-three, lean, fit, with salt-and-pepper hair, Ackman cuts an intimidating presence. He spits out words with machine-gun rapidity, and often with flesh-tearing trenchancy. We spoke at his offices on the 42nd floor of a midtown building that offers panoramic views of Central Park. In the corner of the conference room stands a striking memento: It evokes a crucial skill for a hedge fund manager: Yet he is fallible. His first fund, Gotham Partners, had to be suddenly wound down in late after some illiquid investments left him unable to rebound from a handful of redemptions.
He also lost big on stakes in Borders, J. Risk management is not his strong suit. Ackman is astoundingly competitive. His father wisely let him off the hook the night before, and he scored a And then there was a Hamptons bike ride of , described by William Cohan in Vanity Fair, in which Ackman joined several hedge fund guys and serious cyclists on a mile pleasure ride. Though out of practice, Ackman rushed out in front at an unsustainable pace, became dehydrated, and had to be helped back, barely able to pedal due to excruciating cramping.
The battle has taken a toll. Yet he professes no regrets. But if the commission finds that an MLM is a pyramid scheme—which is considered inherently deceptive—it must shut it down. The best definition of pyramid scheme emerged from a case in which the FTC shuttered a cosmetics marketer called Koscot Interplanetary. Few MLMs are so foolish as to do that.
Instead, they typically pay a distributor—as Herbalife does—based on the products he orders, and on the products ordered by his first three levels of recruits, i. Further complicating the analysis is another striking feature of virtually all MLMs, including Herbalife.
Whereas conventional businesses pay salespeople based on their sales, MLMs pay them based on their purchases and those of their downlines. The year-old Johnson, training near his home in Malibu, recently completed his third Tour TransAlp, a mile, seven-day race across the Alps. While judges and economists have proposed other definitions, most boil down to this: With a pyramid scheme, the product is little more than a fig leaf camouflaging what is, at its core, an elaborate chain letter.
When the FTC ruled that Amway was legitimate in , all other MLMs took steps to make themselves look like Amway—at least on paper—and an industry exploded.
In recent years, however, with consumer advocates protesting that the industry is rife with pyramid schemes, several market leaders have sought to disassociate themselves from the pack. Tupperware quit the Direct Sellers Association in , and Avon dropped out in Both declined to be interviewed for this article.
But Johnson has made key changes to Herbalife during his 12 years there. The question is whether the great white whale Ackman is so doggedly pursuing still exists. In the beginning Hughes, a ninth-grade dropout, sold weight-loss products from the trunk of his car, according to company lore. His main product was Formula 1, which then came in one flavor: That year the company became the subject of a CNN series that highlighted dubious medical claims distributors were making about Herbalife products.
The California attorney general sued the company, and a Senate subcommittee held a hearing. His scrappy performance energized his loyal distributors. Hughes wrote for Herbalife a comically complex, page compensation plan. Such impenetrability is typical of MLM remuneration schemes. Critics say these are intended to perplex the recruit, leaving him no choice but to trust what the recruiter tells him. Defenders of the Herbalife plan say its complexity arises from efforts to reward diligence, punish laziness, and ensure fairness.
The plan created nine main levels of distributor. Ackman will later reject this notion, insisting that these distributors are pursuing the business but failing. At level seven they begin accruing additional bonuses. Only a tiny percentage of distributors reach this level, though precisely how tiny is a matter of dispute.
In in the U. Top-tier distributors are also eligible for the subjective and lucrative Mark Hughes bonus. It has always been hard to make money as an Herbalife distributor. That number excludes income distributors may make from retailing, but also fails to take into account any business expenses they may incur.
Ackman will later argue that a system so slanted toward rewarding the highest tiers—attainable only through recruiting—must be a pyramid scheme. In May , Mark Hughes, 44, was found dead in his bedroom. In two private equity firms—W. They went looking for a turnaround team to spruce it up and take it public again. A headhunter approached Michael Johnson, then in his 17th year at Disney. But the private equity guys promised him he would be in control, stressed that it was about nutrition, and offered him a slice of the company.
In April , Johnson made the move. Johnson tried to quickly launch a new product without consulting the distributors. And they deeply mistrusted him. What does he know? A lot of them felt that when the company went public I would exit. The company could annul their distributorship, but that meant forfeiting a business the distributor had built over years.
If expelled, the distributor might take his whole downline—sometimes thousands of people—to another MLM. Top Herbalife distributors ran several dozen such side businesses at the time. They worked like this. They, in turn, would contact the prospective recruits and send them a video that showed testimonials of top distributors describing astounding wealth they had purportedly amassed in very little time and with no discernible skills.
Herbalife shut down Newest Way to Wealth in , before CEO Johnson was hired, and reached a tentative settlement of the suit a few months after he got there. That fall, he considered quitting. He went to see his mentor, Jerry Perenchio, who was then chairman of Univision. Perenchio asked him a series of rhetorical questions, Johnson recalls: You can stick your tail between your legs and go back to Disney, or you can go in there and exercise your desires and will.
The plan was about product, brand, image, and the business opportunity. The company needed its own upgraded manufacturing facilities, he felt, plus labs to ensure that the products really contained the herbs the labels claimed they did.
To tout the brand, Johnson wanted to sponsor sporting events, teams, and star athletes. It now sponsors more than of them, including Cristiano Ronaldo, the Portuguese soccer star. Finally, and most important, Johnson wanted changes in the way the business opportunity was pursued. That meant curbing some practices while also embracing positive ideas being urged by other distributors, he says. At a videotaped global management retreat in June , viewed by Fortune , Johnson appeared to walk a tightrope, discussing the need for these changes while trying not to alienate powerful distributors.