Ayurvedic medicines: heavy metal and quality concerns explained

Ayurvedic medicines are often described as natural, but NCCIH says that natural does not always mean safe ^[5]. This article explains the concern about heavy metals and product quality in some Ayurvedic products, what symptoms to watch for and how to lower your risk. It uses information from the US Food and Drug Administration (FDA), the US Centers for Disease Control and Prevention (CDC), the US National Center for Complementary and Integrative Health (NCCIH) and the Ministry of Ayush. It does not say that all Ayurvedic products are unsafe, and it does not say that any product helps with a disease.

1. Introduction

A heavy metal is a metal such as lead, mercury or arsenic that can harm the body, especially if it builds up over time ^[1]. The FDA says Ayurvedic products can contain seasonings, plant-based remedies, vitamins, protein sources and minerals, and that some also contain metals such as lead, mercury, arsenic, iron and zinc ^[1]. NCCIH adds that traditional Ayurvedic practice includes products made from plants, animals, metals and minerals ^[3]. The FDA notes that the metals are typically not shown on the label ^[1].

2. What the surveys and reports found

• A survey of users: NCCIH reports a 2015 survey in which 40 percent of users of Ayurvedic products had raised blood lead levels and some also had raised mercury. In tests of products, about one in four had high lead and almost half had high mercury ^[3].
• A case report: a 2015 CDC report linked a high blood lead level in a 64-year-old woman to Ayurvedic products bought online ^[3].
• Pregnancy: the CDC investigated six foreign-born pregnant women in New York City with lead poisoning in 2011 and 2012. They had no symptoms and were found through routine prenatal screening. They had used ten oral Ayurvedic medicines made in India. Lead made up as much as 2.4 percent of some products, and several also contained mercury or arsenic. Two of the six women miscarried before 20 weeks, although the report says it is unclear whether metals or existing reproductive problems played a part ^[2].
• Arsenic: NCCIH says arsenic poisoning from Ayurvedic products is rare but can occur ^[3].

These reports come from the United States. The CDC report says such products can reach people through travel abroad or other channels where regulation is limited ^[2], so the reports cannot tell you the share of products in India that are affected. They do show that contamination can happen.

3. What the quality system in India covers

In India, the Ministry of Ayush describes a system of State licensing authorities, Good Manufacturing Practice and pharmacopoeial standards for Ayurvedic, Siddha and Unani medicines. 55 laboratories are approved under the Rules to test them ^[4]. In 14 laboratories reporting for 2017-18, about 2.6 percent of roughly 6,947 samples failed testing, and actions taken ranged from prosecution and show-cause notices to withdrawal of failed batches and bans on sale ^[4]. The Ministry's page on this topic does not set out heavy metal limits, so you should ask a registered practitioner or the maker about metal testing for a specific product.

4. Symptoms to watch for

The FDA lists these possible signs of heavy metal poisoning ^[1].

• High blood pressure and kidney injury
• Tiredness
• Stomach and bowel symptoms, such as pain, constipation, diarrhoea, nausea and vomiting
• Nervous system effects, such as tingling or burning in the fingers or toes, weak limbs, dizziness, agitation and confusion

These signs can have many other causes, so they do not prove poisoning. A doctor can decide whether a blood test is needed. The FDA also notes that heavy metals can build up over time, that adults and children can become seriously ill, that large amounts taken over a short period can be life-threatening, that chronic arsenic exposure may raise cancer risk, and that metals in a breastfeeding mother can pass to the baby through breast milk ^[1].

5. Who should take extra care

• Pregnant or breastfeeding women: NCCIH says some Ayurvedic products may be harmful in pregnancy or during nursing, so ask your own provider first ^[3]. The CDC advises that doctors ask pregnant patients about remedies and Ayurvedic medicines ^[2].
• Children: NCCIH notes that many supplements have not been tested in children ^[5].
• People with long-term health conditions or on regular medicines: speak to your doctor before using any Ayurvedic product ^[1].

6. How to lower your risk

• Use products from licensed makers and reliable sellers ^[4], and be careful with products bought online ^[3]. The FDA states that there are no FDA-approved Ayurvedic products in the United States ^[1].
• Keep the packaging, batch number and a list of ingredients. Note that terms such as "standardised", "verified" or "certified" on a label do not guarantee quality ^[5].
• Ask your registered practitioner whether a product contains metals or minerals and how it is tested.
• Follow the label instructions. If you have side effects, contact your doctor ^[5].
• Do not use any product to delay seeing a doctor for a medical problem ^[3].
• Report suspected unsafe products to the authority in your country. In the United States, the FDA asks people to report to its MedWatch system ^[1].

7. When to see a doctor

See a doctor if you use Ayurvedic products and have new or unexplained symptoms such as those listed above, or if you are pregnant, planning pregnancy or breastfeeding and use any such product. Take the product, its packaging and a full list of everything you take to the appointment. The FDA advises that doctors ask patients about all the products they use, including Ayurvedic ones ^[1]. If you think you have swallowed a harmful amount, contact your local poison information service or doctor at once.

In an emergency, call your local emergency number (112 in India, 911 in the United States).

8. Conclusion

Some Ayurvedic products have been found to contain lead, mercury or arsenic, usually without a label warning. India licenses and tests these medicines, but some samples fail. You cannot judge safety by looking at a product. Choose licensed products, ask about ingredients, be especially careful in pregnancy and childhood, and tell your doctor about everything you take.