Ayurvedic Medicines Merit a Closer Look

What’s up?
Ayurveda is a system of medicine involving herbal products, massage, and specialized diets; it originated more than 2,000 years ago in India, where it remains commonly practiced. Ayurvedic medicines, sold domestically as dietary supplements in South Asian markets, health food stores, and online, come in two varieties — herbal only and rasa shastra, an ancient practice of deliberately combining herbs with metals such as mercury, lead, iron, and zinc.

Ayurvedic experts say that when rasa shastra remedies are prepared and administered properly, they are safe and therapeutic. But having witnessed lead poisoning in individuals practicing ayurveda and in the absence of strict oversight by the Food and Drug Administration, Robert Saper, an assistant professor of family medicine and director of integrative medicine at the Boston University School of Medicine, decided to investigate the level of metals contained in ayurvedic products sold to American consumers.

Saper and a team of researchers from Boston and India went online and randomly purchased about 200 products, both herbal-only and rasa shastra, from 37 Indian and American manufacturers. The researchers then tested the products for the presence of lead, mercury, or arsenic.

What they found:
About one in five of the ayurvedic medicines contained detectable levels of the three metals (40 percent of the rasa shastra products and 17 percent of the supplements sold as herbal only). The researchers compared the amounts of metals they found to various standards of toxicity, including those from the World Health Organization, the Environmental Protection Agency, and a drinking water safety standard from California. According to a published report of the findings, “all of the metal-containing products exceeded one or more standards of acceptable daily intake of toxic metals.”

The results were similar to Saper’s findings in a 2004 study, in which about 20 percent of ayurvedic medicines produced in South Asia and available in Boston-area stores had potentially harmful levels of lead, mercury, or arsenic.

Why it matters:
“The bottom line,” Saper says, “is that the current regulations in our country for dietary supplements are not rigorous enough and not enforced well enough to protect the consumer.” The regulations are based on the federal Dietary Supplement Health and Education Act of 1994, which requires supplement manufacturers to make supplements that are high quality, safe, and effective. “But,” he says, “they’re not required to demonstrate any of that, and the burden of proving that there is a problem is on an overstretched FDA.” Saper wants the FDA to issue a “firm limit” on the maximum daily dose of metals that one can receive from a supplement and require manufacturers to have their products certified as safe by an independent third-party laboratory.

“I’ve spent 25 years investigating the safety of complementary and alternative medicine. And I’m very committed to ayurveda,” Saper says. “But we need to apply rigorous science to these traditional medical systems to determine which are helpful and safe and which are unhelpful and unsafe.”

What was been the reaction?
“There are people who feel very strongly against any type of alternative medicine who have pointed to this study as proof that these therapies are harmful and ineffective,” says Saper. “And then there are members of the ayurvedic community who believe this is just western physicians bashing alternative medicine.” But Saper says he’s heard from plenty of “individuals in the middle, who have stepped forward and said, ‘Hey, this is an issue we have to deal with or we won’t be able to move forward.’”

Earlier this month, the Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy in India’s Ministry of Health and Family Welfare issued a press release calling Saper’s findings “seriously flawed” and evidence of a “strong bias against ayurvedic medicines.”

What’s next?
Saper is currently working with the New York City Department of Health and Human Hygiene on a study focusing on neighborhoods with high concentrations of South Asian immigrants, interviewing people about their use of ayurvedic products and checking their blood for the presence of metals. They’re also doing a similar study in the Indian state of Kerala. Finally, says Saper, “when we bring up instances of lead poisoning among users of these products, the response of the ayurvedic community is that the medicines were not properly prepared or that the manufacturer cut corners.” So Saper will lead a laboratory analysis of the chemical and physical structure of rasa shastra products made in the traditional way to see if there’s a mechanism whereby these metals can indeed be broken down safely.

Where to find it:
The findings were published in the August 27, 2008, issue of JAMA, the Journal of the American Medical Association.

Chris Berdik can be reached at cberdik@bu.edu.