State Department of Health officials are concerned that the use of dietary or nutritional supplements is causing otherwise healthy adults to suffer acute liver inflammation and failure.
DOH is investigating at least 10 medical cases in Hawaii that started cropping up in May that could be linked to consuming dietary supplements for the purpose of weight loss and/or muscle gain.
The state’s epidemiologist has launched an investigation to determine the cause or causes leading to the medical cases, which have been reported in all four counties.
"Because of the serious nature of the cases, we didn’t think we could afford to wait longer until we had better information," Dr. Sarah Park said Friday. "It’s not very satisfying for us, either, not to be able to name (a cause)."
None of the cases can be traced to an infectious cause, history of engaging in high-risk social activities or common risk factor tied to liver failure. Each case, however, involves use of dietary supplements within the past six months.
The state is working closely with the U.S. Food and Drug Administration and the Centers for Disease Control because a federally regulated supplement with national distribution might be to blame.
The FDA confirmed its involvement in the investigation in a statement sent to the Star-Advertiser.
"We cannot speculate as to the cause of the illnesses," agency spokeswoman Shelly Burgess said in an email. "In the interest of protecting public health, we are moving quickly to learn as much as possible. We recognize that people will be concerned about these illnesses, and we will provide updates as the investigation develops."
So far, Park said she knows of at least one patient who has received a liver transplant and three other patients who are on the transplant waiting list.
"Right there, that definitely told us there’s something up, because that’s not normal" for healthy adults with no underlying medical conditions to be suddenly in need of a liver transplant, she said.
Park said it could be detrimental to name any supplement that might be related to the cases because "then everyone’s so focused on this one thing." She added, "From our standpoint … we do not want to miss potentially what the real reason is behind what’s going on."
Underscoring her point, Park said a recent report found that one patient had been using a completely different supplement than other patients. Also, some cases involve use of a variety of supplements.
"For all we know it’s the combination of something that’s putting some folks at higher risks than others," Park said. "It just verifies for us that we really can’t home down on one product just yet."
So far, adults in their 20s to 50s seem to be affected, with the median age somewhere in the 30s.
"If anyone has developed hepatitis, the liver inflammation or liver injury and they’ve been taking (supplements) … we want those products," Park said. "They shouldn’t throw them out, because we’ll want to know what the lot numbers are and such."
The DOH advises anyone experiencing symptoms such as abdominal pain or discomfort, fatigue, loss of appetite, nausea and/or vomiting, and yellow skin or eyes should consult their health care provider immediately. The department also urges users of dietary or nutritional supplements for weight loss and/or muscle gain to do so with caution and with physician guidance.
