Reports from the U.S., Canada, U.K., Australia, Germany, Holland, Italy, Poland and Croatia indicate that some Ayurvedic preparations contain excess amounts of lead, mercury, arsenic and cadmium, resulting in patients with symptoms such as fatigue, nausea, headache, decreased libido, irritability, abdominal pain, and impaired neurologic development.

For example three months ago, the U.S. Centers for Disease Control and Prevention (CDC) reported that during 2000--2003, a total of 12 cases of lead poisoning, among adults using ayurvedic medications, were discovered in California, Texas, New York, Massachusetts and New Hampshire – all of them involving immigrants from India.

Here are some cases involving Indian American residents in California.

A woman aged 31 years was brought to the emergency room with nausea, vomiting, and lower abdominal pain 2 weeks after a spontaneous abortion. One week later, she was hospitalized for severe anemia that was not improving with iron supplementation. A heavy metals screen revealed a blood lead level (BLL) of 112 µg; while her husband’s BLL was 6 µg. She was put on chelation therapy. No residential or occupational lead sources were identified, but the woman reported taking nine different ayurvedic medications prescribed by a practitioner in India for fertility during a 2-month period, including one pill four times daily. She was asked to discontinue the medications. Analysis of her medications revealed 73,900 ppm lead in the pill taken four times daily and 21, 65, and 285 ppm lead in three other remedies. Her BLL values returned to near normal within 10 months.

A man aged 34 years was evaluated twice in an emergency room for back pain and abdominal pain. A screen for heavy metals revealed a BLL of 80 µg. He was hospitalized for chelation therapy when it was disclosed that he had been taking ayurvedic medications prescribed by a practitioner in India to increase fertility. He had discontinued use the previous day. The 10 preparations included pills, powders, and syrups, most of which were not labeled. He had taken one type of tablet once daily for 3 months; samples of one of these tablets contained 78,000 ppm lead. A second variety of pill contained 36 ppm lead. A home investigation revealed no other sources of lead. His BLL was 17 µg when tested 8 months later.

Finally we have Drs. Cynthia Moore and Robert Adler of the Department of Pediatrics, Childrens Hospital, Los Angeles, reporting a case of chronic lead poisoning in the United States in an Indian child who had an ‘established neurodevelopmental delay’ even while his mother was giving him a natural medication to strengthen his brain. Nine additional cases were reported from Massachusetts, New York, and Texas. The median age of patients was 52 years; five patients were female. The five women were taking the medications for arthritis (one), menstrual health (one), and diabetes (three). The four men were taking the medications for arthritis (one) and diabetes (three).

The CDC report states: ‘Certain traditional or folk medications used in East Indian, Indian, Middle Eastern, West Asian, and Hispanic cultures contain lead and other adulterants. In this report, the majority of persons affected were of Asian Indian or other East Indian descent. Several ayurvedic and other traditional medications do not contain lead; however, lead content has ranged from 0.4 to 261,200 ppm in certain common ayurvedic preparations. Certain branches of ayurvedic medicine consider heavy metals to be therapeutic and encourage their use in the treatment of certain ailments.’

The report goes on to recommend that in the case of patients with nonspecific symptoms, health professionals should consider lead toxicity during diagnosis and request BLL testing.

The CDC report notes that the ayurvedic preparations were in the form of pills, powders and liquids. Two of the patients were taking Guglu tablets, two were taking ‘Jambrulin’, and one was on ‘Sundari Kalp’. Of these Sundari Kalp was shown to contain the highest concentration of lead. The medications taken by seven patients were not identified.

Several years earlier there was the report of a fatal case of ‘lead poisoning associated with Asian Indian folk remedies’ in Florida.

Meanwhile, a German report entitled ‘lead induced anaemia due to traditional Indian medicine: a case report’ has been published from the Department of Medicine III, University Erlangen-Nuremberg, Germany. It reports the case of a western European who had severe anaemia after ingestion of several ayurvedic drugs, obtained during a trip to India. Laboratory findings showed high levels of lead in his blood and urine. The report concludes: ‘Physicians should be aware that with growing international travel and rising self medication with drugs from uncontrolled sources the risk of drug induced poisoning could increase in the future.’

And a British report from Department of Medicine, Leicester Royal Infirmary, entitled ‘Simultaneous exposure to lead, arsenic and mercury from Indian ethnic remedies’ records the case of an Asian woman who was exposed to toxic levels of lead, arsenic and mercury through the use of Indian ayurvedic remedies. The Medical Journal of Australia too has reported ‘a case of lead poisoning following ingestion of Indian herbal medicine (Ayurveda)’ from Flinders Medical Centre.

In February 2002, the European Journal of Clinical Pharmacology reported that ‘the growing popularity of traditional Indian remedies necessitates a critical evaluation of risks associated with their use’ and went on to provide fifteen case reports from the medical literature as documented by Dr E Ernst, Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, UK. Dr Ernst noted: ‘The collective results suggest that heavy metals, particularly lead, have been a regular constituent of traditional Indian remedies. This has repeatedly caused serious harm to patients taking such remedies. The incidence of heavy metal contamination is not known, but one study shows that 64% of samples collected in India contained significant amounts of lead (64% mercury, 41% arsenic and 9% cadmium). These findings should alert us to the possibility of heavy metal content in traditional Indian remedies and motivate us to consider means of protecting consumers from such risks.’

Similarly, the Institute for Medical Research and Occupational Health, Zagreb, Croatia reported ‘Lead poisoning associated with the use of Ayurvedic metal-mineral tonics’ in the Journal of Clinical Toxicology and concluded that ‘Ayurvedic metal-mineral tonics should be strictly controlled.’

WHAT IT MEANS TO CONSUMERS

Traditional herbal preparations used in the Indian practice of Ayurveda, are not regulated by federal or state agencies, and may contain toxic substances. Heavy metals in herbal products can be present as unwanted contaminants or they can be added intentionally. In both Ayurveda and Unani, the traditional medical systems of the Indian subcontinent, the use of herbal formulations containing high levels of heavy metals is considered an important aspect of the therapeutic armamentarium. And the preparation involves a process of detoxification usually by repeated heating and sublimation). It is argued that if such products are carefully formulated and skillfully prescribed they do not result in toxic effects.

If they are present as unwanted contaminants, chances are that the source is the vessel used in the preparation. Though Ayurvedic companies use steel vessels for all their processing, sources in the Ayurveda industry say that there may be small scale units that still use lead-lined vessels which result in contamination.

The U.S. Food and Drug Administration (FDA) has set the “Provisional Total Tolerable Intakes for Lead” at 75 micrograms per day for adults 18 years and older; 25 micrograms per day for pregnant or lactating women; 15 micrograms per day for children ages 7 –17 years; and 6 micrograms per day for children up to 6 years.

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