- Case report
- Open Access
Ayurvedic herbal medicine and lead poisoning
- Krishna S Gunturu†1,
- Priyadharsini Nagarajan†2,
- Peter McPhedran1,
- Thomas R Goodman3,
- Michael E Hodsdon2 and
- Matthew P Strout1Email author
© Gunturu et al; licensee BioMed Central Ltd. 2011
- Received: 15 November 2011
- Accepted: 20 December 2011
- Published: 20 December 2011
Although the majority of published cases of lead poisoning come from occupational exposures, some traditional remedies may also contain toxic amounts of lead. Ayurveda is a system of traditional medicine that is native to India and is used in many parts of world as an alternative to standard treatment regimens. Here, we report the case of a 58-year-old woman who presented with abdominal pain, anemia, liver function abnormalities, and an elevated blood lead level. The patient was found to have been taking the Ayurvedic medicine Jambrulin prior to presentation. Chemical analysis of the medication showed high levels of lead. Following treatment with an oral chelating agent, the patient's symptoms resolved and laboratory abnormalities normalized. This case highlights the need for increased awareness that some Ayurvedic medicines may contain potentially harmful levels of heavy metals and people who use them are at risk of developing associated toxicities.
- Lead poisoning
- basophilic stippling
Ayurvedic medicine is a traditional system native to India . This system stresses the use of natural plant-based medicines, and minerals including sulfur, arsenic, lead, copper and gold are often added to formulations with the belief that these metals are essential components of vital molecules within the human body. In India, over 100 colleges offer degrees in traditional Ayurvedic medicine and in western countries, Ayurvedic medicine is gaining popularity as complementary treatment to modern medicine. Ayurvedic medicines are used to treat a wide spectrum of diseases from headaches to cancer. Currently, the United States does not specify a certification requirement for Ayurvedic practitioners, although many training programs are being offered through state-approved institutions. These practitioners are able to prescribe the medications and sometimes manufacture it themselves.
From 2000 to 2003, the Centers for Disease Control reported 12 cases of lead poisoning in adults associated with Ayurvedic medication intake occurring in five different states . Some Ayurvedic preparations have been found to contain contained lead and/or mercury at 100 to 10,000 times greater than acceptable limits . Although not common in western societies, lead exposure through dietary sources is a well-recognized phenomenon and in past years, calcium supplements have been a source of lead poisoning . In addition to Ayurvedic medicine, other traditional medicines originating from Asian, Middle Eastern and Hispanic cultures have been found to contain lead and other heavy metals . Although many health supplements are now subject to limited government regulation in the U.S. through the Dietary Supplement and Health Education Act of 1994, these medicines are readily obtainable as herbal remedies in health food stores and through the internet and their safety and efficacy are not regulated by government agencies such as the U.S. Food and Drug Administration (FDA) . Thus, without sufficient public awareness, the risk of heavy metal exposure in individuals taking these supplements is quite high. Here, we present a case of lead poisoning secondary to ingestion of Indian Ayurvedic medicine, Jambrulin.
Lab values (Reference)
First emergency room visit
End of chelation
Hemoglobin (12-16 g/dL)
Lead level (< 10 μ g/dL)
Reticulocyte count (0.6-2.7)
ZPP (15-36 μg/dL)
Total bilirubin (< 1.20 mg/dL)
AST (0-34 U/L)
ALT (0-34 U/L)
Exposure to lead through ingestion or inhalation can occur from contaminated air, water, soil, food, and consumer products. One of the largest threats to children is lead-based paint that exists in many homes, especially those built in the U.S. before 1978. Occupational exposure is currently the most common cause of lead poisoning in adults. Findings of National Health and Nutrition Examination Surveys indicate that BLLs are in a continuous decline in all age groups and racial/ethnic populations . Nonetheless, toxic exposure to lead through alternative sources remains a significant and poorly recognized public health problem.
Lead is stored in the blood, bone and soft tissues including the brain, spleen, kidneys, liver, and lungs. Like many other heavy metals, presence of excess levels of lead leads to production of free radicals which subsequently causes oxidative damage of cellular components including DNA and cell membranes . Lead interferes with DNA transcription, enzymatic synthesis of vitamin D, and enzymes that maintain the integrity of the cell membranes. As an electropositive metal, lead has high affinity for negatively charged sulfhydryl groups resulting in denaturation of enzymes such as delta-aminolevulinic acid dehydratase (ALA-D) and ferrochelatase, both of which are important for heme synthesis. The disruption of heme synthesis leads to the accumulation of free erythrocyte protoporphyrins. Anemia often develops at very high BLLs (usually > 80 μg/dL). Inhibition of pyrimidine 5'-nucleotidase can prevent the degradation of ribosomal RNA in red blood cells leading to basophilic stippling on a peripheral smear, a classic finding which can be apparent at BLLs of ~50 μg/dL .
Currently, there are over 600 different Ayurvedic preparations that are manufactured for children and adults as herbal remedies to treat a wide range of illnesses including the common cold, diabetes, infertility, cardiovascular problems, psychiatric disorders, respiratory problems, rashes, and pain [3, 10, 11]. A comprehensive analysis of 193 Ayurvedic medications revealed the presence of heavy metals in ~20% of products analyzed . Although lead was the most commonly detected heavy metal, many products also contained significant amounts of mercury and arsenic. Many of these medications are manufactured both in India and in the U.S. As they are marketed as supplements, they are not regulated by the U.S. FDA and are readily available in health food stores as well as over the internet.
List of reported cases of lead toxicity associated with Ayurvedic mediation1
Abdominal pain, nausea, spontaneous abortion
Anorexia, abdominal pain, weight loss
Ca -EDTA infusion
Vatyog Sahacharadi Gandharvahastadi
Abdominal pain, constipation
Memory loss, anorexia, anhedonia
Memory loss, nausea, abdominal pain
Autonomic dysfunction, pseudo obstruction
Multiple Ayurvedic medications4
Weakness, anorexia, constipation, back pain
Na-EDTA infusion and oral DMSA
Multiple Ayurvedic medicines4
Abdominal pain, constipation, vomiting
Ca-EDTA infusion and oral DMSA
Multiple Ayurvedic medicines4
Weakness, vomiting and abdominal pain
Insomnia, headache, abdominal pain, joint pain
In the case presented here, timely diagnosis and identification of source of exposure were critical in preventing the long-term consequences of lead poisoning. Both the FDA and the Connecticut Department of Public Health were notified and several additional cases of lead poisoning have since been attributed to this diabetic supplement. Despite the body of literature on this topic, lead poisoning through herbal supplements still remains a public health problem. Relatively few health care practitioners are familiar with the traditional medicines and health practices and most patients are unaware of the contents of herbal medications as well as the potential consequences of consuming these agents. Since patients often do not discuss the use of traditional medicines or herbal supplements, it is the responsibility of physician to obtain a detailed history of medications. Additional guidelines regulating the quality of dietary supplements are needed. Enhancing public awareness about the harmful effects of the seemingly innocuous herbal supplements is essential for the prevention of heavy metal poisoning.
Written informed consent was obtained from the patient for publication of this Case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
- Chopra A, Doiphode VV: Ayurvedic medicine. Core concept, therapeutic principles, and current relevance. Med Clin North Am. 2002, 86: 75-89. 10.1016/S0025-7125(03)00073-7. viiView ArticlePubMedGoogle Scholar
- Lead poisoning associated with ayurvedic medications--five states, 2000-2003. MMWR Morb Mortal Wkly Rep. 2004, 53: 582-584.Google Scholar
- Saper RB, Phillips RS, Sehgal A, Khouri N, Davis RB, Paquin J, Thuppil V, Kales SN: Lead, mercury, and arsenic in US- and Indian-manufactured Ayurvedic medicines sold via the Internet. JAMA. 2008, 300: 915-923. 10.1001/jama.300.8.915.PubMed CentralView ArticlePubMedGoogle Scholar
- Kim M, Kim C, Song I: Analysis of lead in 55 brands of dietary calcium supplements by graphite furnace atomic absorption spectrometry after microwave digestion. Food Addit Contam. 2003, 20: 149-153. 10.1080/0265203021000053588.View ArticlePubMedGoogle Scholar
- Gogtay NJ, Bhatt HA, Dalvi SS, Kshirsagar NA: The use and safety of non-allopathic Indian medicines. Drug Saf. 2002, 25: 1005-1019. 10.2165/00002018-200225140-00003.View ArticlePubMedGoogle Scholar
- Marcus DM, Grollman AP: Botanical medicines--the need for new regulations. N Engl J Med. 2002, 347: 2073-2076. 10.1056/NEJMsb022858.View ArticlePubMedGoogle Scholar
- Meyer PA, Pivetz T, Dignam TA, Homa DM, Schoonover J, Brody D: Surveillance for elevated blood lead levels among children--United States, 1997-2001. MMWR Surveill Summ. 2003, 52: 1-21.PubMedGoogle Scholar
- Flora SJ, Mittal M, Mehta A: Heavy metal induced oxidative stress & its possible reversal by chelation therapy. Indian J Med Res. 2008, 128: 501-523.PubMedGoogle Scholar
- Valentine WN, Paglia DE, Fink K, Madokoro G: Lead poisoning: association with hemolytic anemia, basophilic stippling, erythrocyte pyrimidine 5'-nucleotidase deficiency, and intraerythrocytic accumulation of pyrimidines. J Clin Invest. 1976, 58: 926-932. 10.1172/JCI108545.PubMed CentralView ArticlePubMedGoogle Scholar
- Ernst E: Heavy metals in traditional Indian remedies. Eur J Clin Pharmacol. 2002, 57: 891-896. 10.1007/s00228-001-0400-y.View ArticlePubMedGoogle Scholar
- Lynch E, Braithwaite R: A review of the clinical and toxicological aspects of 'traditional' (herbal) medicines adulterated with heavy metals. Expert Opin Drug Saf. 2005, 4: 769-778. 10.1517/147403126.96.36.1999.View ArticlePubMedGoogle Scholar
- Rolfe PB, Marcinak JF, Nice AJ, Williams RH: Use of zinc protoporphyrin measured by the Protofluor-Z hematofluorometer in screening children for elevated blood lead levels. Am J Dis Child. 1993, 147: 66-68.PubMedGoogle Scholar
- Gupta N, Goswami B, Singh N, Koner BC, Garg R: Lead poisoning associated with Ayurvedic drug presenting as intestinal obstruction: a case report. Clin Chim Acta. 2011, 412: 213-214. 10.1016/j.cca.2010.10.007.View ArticlePubMedGoogle Scholar
- Giampreti A, Bonetti C, Lonati D, Manzo L, Locatelli CA: A young Indian male with abdominal pain. Clin Toxicol (Phila). 2011, 49: 191-192. 10.3109/15563650.2011.559474.View ArticleGoogle Scholar
- Wijeratne NG, Doery JC, Graudins A: Occult lead poisoning from Ayurvedic medicine produced, prescribed and purchased in India. Med J Aust. 2011, 194: 205-206.PubMedGoogle Scholar
- Singh S, Mukherjee KK, Gill KD, Flora SJ: Lead-induced peripheral neuropathy following Ayurvedic medication. Indian J Med Sci. 2009, 63: 408-410. 10.4103/0019-5359.56114.View ArticlePubMedGoogle Scholar
- Atre AL, Shinde PR, Shinde SN, Wadia RS, Nanivadekar AA, Vaid SJ, Shinde RS: Pre- and posttreatment MR imaging findings in lead encephalopathy. AJNR Am J Neuroradiol. 2006, 27: 902-903.PubMedGoogle Scholar
- Roche A, Florkowski C, Walmsley T: Lead poisoning due to ingestion of Indian herbal remedies. N Z Med J. 2005, 118: U1587.PubMedGoogle Scholar
- Madan K, Sharma PK, Makharia G, Poojary G, Deepak KK: Autonomic dysfunction due to lead poisoning. Auton Neurosci. 2007, 132: 103-106. 10.1016/j.autneu.2006.10.002.View ArticlePubMedGoogle Scholar
- Weide R, Engelhart S, Farber H, Kaufmann F, Heymanns J, Koppler H: [Severe lead poisoning due to Ayurvedic indian plant medicine]. Dtsch Med Wochenschr. 2003, 128: 2418-2420.View ArticlePubMedGoogle Scholar
- van Vonderen MG, Klinkenberg-Knol EC, Craanen ME, Touw DJ, Meuwissen SG, De Smet PA: Severe gastrointestinal symptoms due to lead poisoning from Indian traditional medicine. Am J Gastroenterol. 2000, 95: 1591-1592.View ArticlePubMedGoogle Scholar
- Raviraja A, Vishal Babu GN, Sehgal A, Saper RB, Jayawardene I, Amarasiriwardena CJ, Venkatesh T: Three cases of lead toxicity associated with consumption of ayurvedic medicines. Indian J Clin Biochem. 2010, 25: 326-329. 10.1007/s12291-010-0051-9.PubMed CentralView ArticlePubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.