https://stacks.cdc.gov/view/cdc/37676/cdc_37676_DS1.pdf

Toxicological Profile for Lead

ContextLead, mercury, and arsenic intoxication have been associated with the
use of Ayurvedic herbal medicine product (HMPs).ObjectivesTo determine the prevalence and concentration of heavy metals in Ayurvedic
HMPs manufactured in South Asia and sold in Boston-area stores and to compare
estimated daily metal ingestion with regulatory standards.Design and SettingSystematic search strategy to identify all stores 20 miles or less from
Boston City Hall that sold Ayurvedic HMPs from South Asia by searching online
Yellow Pages using the categories markets, supermarkets, and convenience stores, and business names containing the word India,
Indian cities, and Indian words. An online national directory of Indian grocery
stores, a South Asian community business directory, and a newspaper were also
searched. We visited each store and purchased all unique Ayurvedic HMPs between
April 25 and October 24, 2003.Main Outcome MeasuresConcentrations (μg/g) of lead, mercury, and arsenic in each HMP
as measured by x-ray fluorescence spectroscopy. Estimates of daily metal ingestion
for adults and children estimated using manufacturers’ dosage recommendations
with comparisons to US Pharmacopeia and US Environmental Protection
Agency regulatory standards.ResultsA total of 14 (20%) of 70 HMPs (95% confidence interval, 11%-31%) contained
heavy metals: lead (n = 13; median concentration, 40 μg/g; range,
5-37 000), mercury (n = 6; median concentration, 20 225
μg/g; range, 28-104 000), and/or arsenic (n = 6; median
concentration, 430 μg/g; range, 37-8130). If taken as recommended by the
manufacturers, each of these 14 could result in heavy metal intakes above
published regulatory standards.ConclusionsOne of 5 Ayurvedic HMPs produced in South Asia and available in Boston
South Asian grocery stores contains potentially harmful levels of lead, mercury,
and/or arsenic. Users of Ayurvedic medicine may be at risk for heavy metal
toxicity, and testing of Ayurvedic HMPs for toxic heavy metals should be mandatory.

Heavy Metal Content of Ayurvedic Herbal Medicine Products

Context Lead, mercury, and arsenic have been detected in a substantial proportion of Indian-manufactured traditional Ayurvedic medicines. Metals may be present due to the practice of rasa shastra (combining herbs with metals, minerals, and gems). Whether toxic metals are present in both US- and Indian-manufactured Ayurvedic medicines is unknown. Objectives To determine the prevalence of Ayurvedic medicines available via the Internet containing detectable lead, mercury, or arsenic and to compare the prevalence of toxic metals in US- vs Indian-manufactured medicines and between rasa shastra and non–rasa shastra medicines. Design A search using 5 Internet search engines and the search terms Ayurveda and Ayurvedic medicine identified 25 Web sites offering traditional Ayurvedic herbs, formulas, or ingredients commonly used in Ayurveda, indicated for oral use, and available for sale. From 673 identified products, 230 Ayurvedic medicines were randomly selected for purchase in August-October 2005. Country of manufacturer/Web site supplier, rasa shastra status, and claims of Good Manufacturing Practices were recorded. Metal concentrations were measured using x-ray fluorescence spectroscopy. Main Outcome Measures Prevalence of medicines with detectable toxic metals in the entire sample and stratified by country of manufacture and rasa shastra status. Results One hundred ninety-three of the 230 requested medicines were received and analyzed. The prevalence of metal-containing products was 20.7% (95% confidence interval [CI], 15.2%-27.1%). The prevalence of metals in US-manufactured products was 21.7% (95% CI, 14.6%-30.4%) compared with 19.5% (95% CI, 11.3%-30.1%) in Indian products (P = .86). Rasa shastra compared with non–rasa shastra medicines had a greater prevalence of metals (40.6% vs 17.1%; P = .007) and higher median concentrations of lead (11.5 μg/g vs 7.0 μg/g; P = .03) and mercury (20 800 μg/g vs 34.5 μg/g; P = .04). Among the metal-containing products, 95% were sold by US Web sites and 75% claimed Good Manufacturing Practices. All metal-containing products exceeded 1 or more standards for acceptable daily intake of toxic metals. Conclusion One-fifth of both US-manufactured and Indian-manufactured Ayurvedic medicines purchased via the Internet contain detectable lead, mercury, or arsenic.

https://jamanetwork.com/journals/jama/articlepdf/182460/joc80084_915_923.pdf

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

ObjectiveWe reviewed the sources of lead in the environments of U.S. children, contributions to children’s blood lead levels, source elimination and control efforts, and existing federal authoritie...

Lead exposures in U.S. Children, 2008: implications for prevention.

This review focuses on the impacts of lead exposure on reproductive health and outcomes. High levels of paternal lead exposure (>40 microg/dl or >25 microg/dl for a period of years) appear to reduce fertility and to increase the risks of spontaneous abortion and reduced fetal growth (preterm delivery, low birth weight). Maternal blood lead levels of approximately 10 microg/dl have been linked to increased risks of pregnancy hypertension, spontaneous abortion, and reduced offspring neurobehavioral development. Somewhat higher maternal lead levels have been linked to reduced fetal growth. Some studies suggest a link between increased parental lead exposure and congenital malformations, although considerable uncertainty remains regarding the specific malformations and the dose-response relationships. Common methodological weaknesses of studies include potential exposure misclassifications due to the frequent unavailability of exposure biomarker measurements at biologically appropriate times and uncertainty regarding the best exposure biomarker(s) for the various outcomes. A special concern with regard to the pregnant woman is the possibility that a fetus might be exposed to lead mobilized from bone stores as a result of pregnancy-related metabolic changes, making fetal lead exposure the result of exposure to exogenous lead during pregnancy and exposure to endogenous lead accumulated by the woman prior to pregnancy. By reducing bone resorption, increased calcium intake during the second half of pregnancy might reduce the mobilization of lead from bone compartments, even at low blood lead levels. Subgroups of women who incurred substantial exposures to lead prior to pregnancy should be considered to be at increased risk.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/bdra.20127

Teratogen update: Lead and pregnancy

Although approximately 95% of lead poisoning among US adults results from occupational exposure (1), lead poisoning also can occur from use of traditional or folk remedies (2-5) Ayurveda is a traditional form of medicine practiced in India and other South Asian countries Ayurvedic medications can contain herbs, minerals, metals, or animal products and are made in standardized and nonstandardized formulations (2) During 2000-2003, a total of 12 cases of lead poisoning among adults in five states associated with ayurvedic medications or remedies were reported to CDC (Table) This report summarizes these 12 cases Culturally appropriate educational efforts are needed to inform persons in populations using traditional or folk medications of the potential health risks posed by these remedies



TABLE

Reported cases of adult lead poisoning related to ayurvedic medications, by state and selected characteristics — United States, 2000-2003



The first three cases described in this report were reported to CDC by staff at Dartmouth Hitchcock Medical Center at Dartmouth Medical School, New Hampshire; the California Childhood Lead Poisoning Prevention Program; and the California Department of Health Services To ascertain whether other lead poisoning cases associated with ayurvedic medicines had occurred, an alert was posted on the Epidemic Information Exchange (Epi-X), and findings from the cases in California were posted on the Adult Blood Lead Epidemiology and Surveillance (ABLES) listserv Nine additional cases were reported by state health departments in Massachusetts, New York, and Texas (Table)

K Hipkins

Papers

Lead Poisoning Associated with Ayurvedic Medications — Five States, 2000-2003