High levels of metals found in ayurvedic medicines purchased on the internet

High levels of metals found in ayurvedic medicines purchased on the internet

A study published in the August 27 issue of JAMA finds that of several Ayurvedic medicines purchased on the Internet, about 20% have unacceptably high levels of lead, mercury, or arsenic.

Ayurvedic medicines - based on a traditional medical system commonly used in India - are employed by a majority of India's 1.1 billion population as well as peoples from South Asia and other localities. Robert B. Saper, M.D., M.P.H., (Boston University School of Medicine and Boston Medical Center) and colleagues write that, "Since 1978 more than 80 cases of lead poisoning associated with Ayurvedic medicine use have been reported worldwide." Some ayurvedic medicines are herbal only, while others are considered rasa shastra - an ancient practice of mixing herbs with metals (such as mercury, lead, iron, zinc), minerals (such as mica), and gems (such as pearl). Experts maintain that rasa shastra methods and medicines are safe and therapeutic if prepared and administered properly. However, the metal content in Ayurvedic medicines sold on the Internet and in those manufactured in the United States has been unknown.

The study conducted by Saper and colleagues was designed to determine the extent of detectable lead, mercury, or arsenic levels in Ayurvedic medicines available on the Internet and to compare it to the prevalence of toxic metals between U.S. and Indian-manufactured products. The researchers analyzed both rasa shastra and non-rasa shastra medicines. The investigation began with an Internet search using the keywords "Ayurveda" and "Ayurvedic medicine." This led to 673 products, 230 of which were Ayurvedic medicines that were randomly selected for purchase between August and October 2005. Researchers recorded information on the country of the manufacturer and Web site supplier, rasa shastra status, and claims of Good Manufacturing Practices. Techniques such as x-ray fluorescence spectroscopy were employed to measure levels of metals. Of the 230 selected products, 193 were received and analyzed.

About 20.7% of the products contained metals - 21.7% of U.S.-manufactured products and 19.5% of Indian-manufactured products. Compared to non-rasa shastra products, rasa shastra medicines were more than twice as likely to contain detectable metals and had higher concentrations of lead and mercury. Ninety-five percent of metal-containing products were sold by U.S web sites - 75% claimed Good Manufacturing Practices. Every product that contained metal exceeded at least 1 standard for acceptable daily metal intake. The authors write that, "Several Indian-manufactured rasa shastra medicines could result in lead and/or mercury ingestions 100 to 10,000 times greater than acceptable limits."

"A 2005 Institute of Medicine report concluded that 'the regulatory mechanisms for monitoring the safety of dietary supplements … [should] be revised. The constraints imposed on FDA [U.S. Food and Drug Administration] with regard to ensuring the absence of unreasonable risk associated with the use of dietary supplements make it difficult for the health of the American public to be adequately protected," conclude Saper and colleagues. "New FDA regulations and current Indian policies do not specify any maximum acceptable concentrations or daily dose limits for metals in dietary supplements for domestic use. We suggest strictly enforced, government-mandated daily dose limits for toxic metals in all dietary supplements and requirements that all manufacturers demonstrate compliance through independent third-party testing."

Lead, Mercury, and Arsenic in US- and Indian-Manufactured Ayurvedic Medicines Sold via the Internet

Robert B. Saper; Russell S. Phillips; Anusha Sehgal; Nadia Khouri; Roger B. Davis; Janet Paquin; Venkatesh Thuppil; Stefanos N. Kales

JAMA . 300[8]: pp. 915-923.

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Section Issues On Medicine: Medical practice