Hepatotoxicity associated with the use of white flood, a nutritional supplement

Complementary and alternative medical (CAM) therapies are used by a large percentage of the US population. These agents are poorly regulated. Several of these agents have been associated with hepatotoxicity. We present the frst case report of cholestatic hepatitis attributed to the use of White Flood, an herbal muscle-building supplement. A patient using this agent presented with signifcant cholestatic hepatitis. A full serologic and imaging evaluation failed to reveal any other likely sources. His liver tests normalized with removal of the suspected offending agent. Evidence to support White Flood as the causative agent include a correct temporal relationship, lack of other likely etiology after extensive evaluation, and resolution of symptoms after withdrawal of this agent. Clinicians should be aware that this supplement may have the potential to induce cholestatic hepatitis.