Researchers documented a case of severe drug-induced liver injury in a 26-year-old woman following 5 months of Nutrafol use, according to findings presented at the 2024 American College of Gastroenterology Annual Meeting.

The patient presented with jaundice and significantly elevated liver enzymes: total bilirubin 22, AST 1247, ALT 1318, and alkaline phosphatase 122. Previous liver function tests were normal 1 month before starting the supplement.

"Look, you couldn’t pay me to take Nutrafol for hair loss," said Jennifer Gunter, MD, in a post on her Vajenda website. "I would never take a product with a proprietary blend or turmeric," the OB/GYN physician added.

Clinical workup revealed elevated iron, increased CA 19-9, and elevated serum immunoglobulins without eosinophilia. The patient tested negative for viral hepatitis, alpha-1 antitrypsin deficiency, CMV, Epstein Barr virus, autoimmune markers, acetaminophen toxicity, alcohol use, and hereditary hemochromatosis.

Imaging studies, including CT abdomen, abdominal ultrasound with Doppler, and MRCP, showed no primary hepatic, biliary, or vascular pathologies. A liver biopsy demonstrated moderate portal inflammation, marked necroinflammatory injury, parenchymal collapse, and cholestasis.

During supplementation with Nutrafol, the patient, who had a history of obesity but an otherwise normal physical exam, was also consuming Mullerian leaf tea. Patients taking the supplement should undergo regular liver enzyme testing.

Potentially hepatotoxic ingredients in Nutrafol include turmeric (Grade B evidence for hepatotoxicity), ashwagandha and horsetail (Grade C), saw palmetto (Grade D), and kelp minerals and resveratrol (Grade E).

Liver function improved following discontinuation of the supplement, establishing a temporal relationship between Nutrafol use and liver injury.

"Nutrafol is inadequately studied, and there is no real safety data, which is especially concerning given the high amounts of vitamin A and selenium. The one randomized double-blinded trial that I found seems to have excluded the most common causes of hair loss, and now, a case report links the product to liver failure," said Dr. Gunter.

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