Many people who turn to traditional herbal remedies to treat their aches and pains believe that even if the treatment turns out to be ineffective, it will at least be harmless.
But that’s not necessarily true, as underscored by a recent case study published in the journal BMJ Case Reports.
The report, written by medical student Amelia Breyre and Dr. Judith Green-McKenzie, both of the University of Pennsylvania Perelman School of Medicine, describes how a 26-year-old man — a graduate student at the university — developed a serious case of lead poisoning after being treated for low back pain with four different Ayurvedic herbal medicines while vacationing in India. He had continued to take the medicines after he returned to Pennsylvania.
Within three months, the student was at a hospital emergency room, complaining of severe upper abdominal pain. He told the doctors he had been experiencing decreased appetite, weight loss, and dark-colored stools for about two weeks. During the previous 24 hours he had also been nauseated and had vomited up some blood.
The student was admitted to the hospital, and underwent a series of tests. One of the tests revealed he had a blood lead level (BLL) of 94.8 ug/dL. The typical BLL for adults in the U.S. is less than 10 ug/dL, and a BLL above 80 ug/dL is considered “extremely dangerous,” according to the New York State Department of Health.
The student was given the drug succimer, which helps remove lead from the body. He was also told to stop taking the Ayurvedic medicines.
Within three months, his symptoms had disappeared. He remained asymptomatic three years later, and his blood lead levels had fallen to less than 20 ug/dL.
Many other incidents
This is not an isolated case. As Breyre and Green-McKenzie point out in their paper, complementary and alternative medicines — particularly Ayurvedic herbal concoctions — have been implicated in many cases of lead poisoning around the world, including here in the United States.
In a 2015 study, researchers tested the blood of 115 U.S. users of Ayurvedic herbal medicines and found that 46 of them (40 percent) tested positive for lead poisoning. Several other clusters of lead poisoning among people taking Ayurvedic medicines have popped up around the country during the past decade, including six cases among pregnant women in New York City in 2011-2012.
Here in Minnesota, state health officials have reported several cases in recent years of Minnesota children returning from visits to India with high levels of lead or mercury in their blood — levels traced back to Ayurvedic herbal treatments.
Two milleniums old
Why are Ayurvedic herbal medicines — which have been used in India for more than 2,000 years — likely to contain lead and other toxic metals? Breyre and Green-McKenzie explain:
In Ayurveda, Rasashastra is a sub-division that deals with the study of metal and mineral. Metals, such as mercury, lead and arsenic, are used as adjuvants to the primary herbal therapy for many chronic illnesses including rheumatoid arthritis, epilepsy, insomnia and asthma. Metals are believed to exert their own therapeutic effect, enhance the potency of other medications and facilitate drug delivery to target site.
Some of the indications for therapeutic Ayurvedic use of lead include treatment of diabetes and worms. It is also used as an aphrodisiac. Doses of metals used in practice are based on recommendations given in ancient Ayurvedic texts. It is estimated that roughly 35–40% of the [about] 6,000 medicines in the Ayurvedic formulary intentionally contain at least one metal.
That proportion appears to be only slightly higher than here in the U.S. In 2004, researchers estimated that 20 percent of the Ayurvedic herbal medicines produced in South Asia and sold in the Boston area contained potentially toxic levels of lead, mercury and/or arsenic.
A dangerous assumption
Never assume that an herbal remedy is safe simply because it’s “traditional.” We’ve learned a great deal about the human body during the past 2,000 years, including the fact that many “natural” elements, like lead, can cause devastating harm.
Also, keep in mind that, as I’ve noted here before, the essentially unregulated herbal-supplement industry is rife with dubious practices, including out-and-out fraud.
A study published in 2013 found, for example, that many herbal products sold as alternative medicine in the U.S. are contaminated with products not listed on their labels.
The herbal-product industry “suffers from unethical activities by some of the manufacturers, which includes false advertising, product substitution, contamination and use of fillers,” the authors of that study concluded.
To keep you and your family safe, the Minnesota Department of Health recommends the following:
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Talk to you health care provider about the herbs or Ayurvedic medications you are taking.
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Show your health care provider any medicines you are taking including the labels.
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Think carefully about each herbal medicine and whether it is serving you.
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Understand the ingredients of any herbal medicines you take, and make certain you can trust that the product does not contain lead, arsenic or mercury.
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Be especially careful about any medications given to young children and pregnant women.
FMI: You can read the case study report on BMJ Case Reports’ website.
Timely Without Audience
The image of one employee with sweatband around stomach is not comforting, certainly.
The cautions and prescribed reviews are worthy, yet without practical efficiencies. Herbals are quite loosely regulated, if at all, given their status of food supplement rather than drug. How one is supposed to determine ancillary ingredients is unstated here. That simply is not possible unless found in some independent review (unlikely). Only primary ingredients are labelled, certainly not trace “lead, arsenic or mercury.” As for physician guidance: __________. Some clinic databases now request patients to note supplements used; however, contraindications are sparse.
Maybe the best advice is to follow public preferences of well-established sources. Unfortunately, market forces may be more effective regulation than consumer diligence.
The best current regulatory regime: caveat emptor.
What’s the harm?
One needs to wonder what ‘alternative’ medicines are an alternative to. The answer is: science-based medicine. As to the question of ‘what’s the harm?’, take a look at the information on http://www.whatstheharm.net.
There’s plenty of factual documentation of the problems caused by ‘alternative’ remedies and supplements. Where is the evidence – beyond anecdote – of the value of ‘alternatives’?
Probiotics, for one
Only recently recognized by conventional physicians for their value, these natural agents are a staple of modern supplement sales. They promote effective digestive behavior rather than simply suppress bad behavior addressed by far too much indiscriminate and excessive prescription of various antibiotics.
Greek yogurt has become ubiquitous due to this recognition.