In response to reports of acute hepatic and renal toxicity due to ingestion of bile from Grass Carp, we became aware of a potential danger to male diabetic patients in southwestern Saudi Arabia who drank raw sheep bile as a traditional remedy for diabetes
Methodology
From a list of all 73 diabetic patients using two clinics serving one village, Al Wadein (population 5640), 30 who had used traditional medicine were selected for investigation. We interviewed them about underlying illnesses, drinking bile and illnesses that immediately followed. We obtained serum chemistries from medical records taken over the year before exposure (baseline) immediately after and two months after bile exposure and compared these findings.
Results
Fourteen of the thirty diabetics (age 53 to 78) including five on dialysis for chronic renal failure reported that they had ingested from 15 to 210 ml of sheep's bile for treatment of diabetes at some time during a four year period. All immediately developed nausea and anorexia and those who drank more than 15 ml also had vomiting and diarrhea. Mean baseline BUN serum creatinine and alanine aminotransferase (ALT) of the group that drank bile and did not drink bile were not different. After (<1 week) drinking bile the mean BUN was 144 mg/100 ml compared to a baseline of 77 (P<0.001, paired t-test), mean ALT was 295 U/l compared to a baseline of 27 (P<0.001, paired t-test) mean creatinine was 6 mg/100 ml compared to a baseline of 0.9 mg/100 ml (P<0.001, paired t-test). By linear regression serum ALT (r=0.88, 95% CI 0.76 to 0.96), and creatinine (r=0.63, 95% CI 0.34 to 0.81) increased with increasing dose of bile. All biochemical indicators of hepatic and renal toxicity returned to baseline levels two months after the acute toxicity. All patients had stopped prescribed antidiabetic medications during their traditional treatment.
Conclusion
The similarity of the reaction to sheep bile to the toxicity described from carp bile indicates that a component of bile common to both fish and mammals is responsible for the observed reaction. Traditional remedies are common in Saudi Arabia. They can be toxic and can divert patients from medically effective medication. In response, physicians in southwestern Saudi Arabia have been alerted to this dangerous remedy.