It’s time to watch the labelling on those herbal pills carefully.
Indians may unknowingly be exposing themselves to increased risks of kidney failures and even forms of cancer by using traditionally popular herbal medicines that contain toxic acids, British researchers have warned.
The medicines to watch out for are made from herbs like birthworts, popular in the traditional Indian medical practices of Ayurveda and Siddha as remedies for excess weight, asthma, arthritis, snake bites, fever and even malaria. Also commonly used in China and South East Asia, these herbs are widely sold online – even though the US Food and Drug Administration (FDA) and many European nations have banned them.
“We have found evidence that many millions of people continue to be exposed to significant health risk due to these herbal medicines, widely used in China and India,” said Professor Graham Lord at King’s College London, who led the international research team that published its findings on Monday in the journal Annals of Internal Medicine.
The absence of data means that scientists haven’t been able to confirm any specific cases of kidney failure caused by herbal medication in India, Lord said. But other independent research has also pointed to the likelihood of these being a cause for kidney diseases in several instances the country.
“And we predict that there may be many cases which have gone unrecognized or misdiagnosed,” Lord said. “The idea is to raise awareness, because there’s a real need for it.”
The concerns involve herbs containing aristolochic acids, known to trigger kidney failure and bladder cancer. Known in Hindi as the hooka ber, the Indian Birthwort found across most of the country contains the chemicals. A creeper commonly found in Kerala – known locally as karalayam – and a plant known in Ayurveda as Kitamaari also have aristolochic acids.
Over 250 companies are licensed by the Department of AYUSH – the government’s traditional medicine regulator – to manufacture and sell Ayurveda medicines. Their laboratories are certified by the Department of Science and Industrial Research (DSIR).
But the role of the AYUSH regulators is primarily to scrutinize medicines to see that they comply with traditional medicine formulae laid down in ancient Sanskrit texts. Any adulteration is caught. But if medicines contain herbs that are approved traditionally, but are found problematic in recent research – like herbs with aristolochic acids -- they could escape scrutiny, a senior AYUSH official conceded. “But we can’t was our hands off these concerns, and will definitely look into them,” said the official, who requested anonymity because he is not authorized to speak with the press.
Tracking the use of these herbs will not be easy.
Thousands of local practitioners – commonly known as hakims and vaids – who are the most common sources of herbal medicines for many Indians, are outside any regulatory framework.
“This is definitely a cause for concern and points to the need for stronger regulations,” said Dr. Shirley Telles, director of research at Patanjali Research Foundation in Haridwar. The foundation, started by yoga guru Baba Ramdev, does not use any herbs containing aristolochic acids, Telles said.
The multiple commonly used names for these herbs also make it difficult to track – without specific tests -- whether particular products contain these toxic chemicals.
“What we need in India is a uniform standard, like that applied by the US FDA, to segregate evidence-based medicine from the rest,” Telles said.
Lord accepted the challenges India faces in regulating practices as old as the scriptures that define this country.
But experiences in Europe – though not directly or completely replicable in India – suggest that working with traditional medicine practitioners and companies that manufacture herbal medicines can help.
“In the UK too, the herbal medicine industry was much less regulated 10 years back than it is today,” Lord said. “And it’s still less regulated than other medicines.” But by working closely with manufacturers, and by imposing controls on imports of toxic herbs, the UK managed to begin regulating the industry.
Next, the country’s regulators and researchers worked with Chinese practitioners of traditional medicine – who were using the herbs containing harmful chemicals. “They reacted very positively,” Lord said.
The challenges in countries like India and China – where the herbs are sources from – are more complex. Import regulations won’t work. And traditional medicine is closely linked with faith, passed on over generations. Criticism, especially from Western scientists, of Indian traditional medicine is often greeted with counter-charges of a bias driven by supposed intentions to damage the credibility of ancient sciences.
But even independent Indian evidence suggests that a closer look at herbal medication may be useful. Back in 1993, scientist MK Mani reported chronic intestitial nephritis – the specific condition caused by aristolochic acids – in 28% out of 2028 Indian patients with chronic kidney disease.
“We are not arguing against herbal medicines at all. Much of it is good,” Lord said. “It is only few herbs that are a matter of concern.”