“We, for the first time, found severe liver injury, proven using biopsy, related to the herb tinospora cordifolia,” said hepatologist Dr Aabha Nagral, lead author of a study published in Journal of Clinical and Experimental Hepatology, an international peer-reviewed journal published by the Indian National Association for the Study of the Liver.
Liver transplant surgeon Dr AS Soin, who wasn’t connected to the study, said he too had seen five giloy-related liver damage cases in his practice that spans Delhi to Mumbai. One of his patients, too, died. “Many took to giloy during the pandemic to boost their immunity and as an antioxidant. Unfortunately, many suffered liver toxicity due to it,” he said.
Except for the deaths, the other patients made full recovery a couple of months after stopping the herb.
Giloy is among the several alternative medicines recommended by the Ayush ministry as an immune booster against the Covid-causing SARS-CoV-2. However, the patients included in the Mumbai study started consuming it without medical advice.
Their liver biopsies revealed the liver damage was possibly due to an “autoimmune” response. Normally, the body’s immune system attacks foreign elements such as a virus and this is called an immune response. However, in people with certain disorders, the immune response attacks the body’s own healthy cells and tissues as well called an auto-immune response.
While giloy, said Dr Nagral, has immune-boosting properties, if taken in excess or in a “subset of patients” with auto-immune disorders, it triggers an auto-immune response. “In these six patients, giloy seems to have triggered an auto-immune response against the liver cells, causing severe life-threatening liver injury,” she said.
A 41-year-old Chembur resident was the first patient with giloy-related “liver injury” identified in Jaslok Hospital. “After one of my colleagues got Covid-19, some of us started taking a brew of giloy every morning,” he told TOI. He found a giloy plant in the neighborhood and took it for 45 days before developing jaundice.
The other patients included a 38-year-old thalassemia minor patient who consumed a brew made out of three to four twigs of giloy in 15 ml of water every day for six months. Other patients had hypothyroidism.
Dr Soin said patients who already have baseline liver damage due to diabetes or alcohol are more susceptible. “On biopsy, these patients exhibit features of DILI (drug-induced liver injury) and autoimmune hepatitis. Those with pre-existing liver damage may go into advanced liver failure,” he added.
There is a need for regulatory authorities to put out a warning on giloy tablets and syrups about possible liver injury, said the doctors. “This herb grows in the backyards of people’s homes and is freely available and manufactured by pharma companies,” Dr Nagral said. “I am not an Ayush expert. There are many serious Ayush researchers doing good work, but the impression that Ayush drugs are harmless in terms of side-effects may not be correct,” she added.