A recent paper published in CMAJ (Canadian Medical Association Journal) highlights the case of lead poisoning in a young woman caused by Ayurvedic medicine, and the complexities of diagnosing this rare disease."Given that lead poisoning is uncommon and its manifestations are nonspecific, patients are often seen by many health care providers before a diagnosis is made," wrote co-authors Julian Gitelman, Ph.D., of the University of Toronto's Dalla Lana School of Public Health. "A careful exposure history is critical to making a diagnosis."
The patient is a 39-year-old female who visited the emergency department three times within 6 weeks due to abdominal pain, constipation, nausea, and vomiting. On her third visit, she was admitted with anemia and possible gastrointestinal bleeding. Extensive invasive investigations failed to reveal what was causing her symptoms. At a follow-up visit a few weeks later, she reported that she had been taking daily Ayurvedic medicines to treat infertility for over a year. Her blood lead level was as high as 55µg/dL, while normal levels are below 2µg/dL. The patient was discontinued from Ayurvedic treatment and chelation therapy was started. Her blood lead levels dropped and her symptoms improved.
Once the diagnosis of lead poisoning was made, the medical team contacted Public Health Ontario (PHO), which tested 17 different pill samples provided by the patient. After tests found high levels of lead in most of the pills, the PHO contacted the local public health unit, Toronto Public Health and Health Canada, which regulates natural health products. A joint investigation into an Ayurveda clinic has resulted in the seizure of hundreds of pills due to non-compliance with natural health products regulations. Both Health Canada and Toronto Public Health have issued public advisories warning people that this particular company's products are hazardous to health.
The authors emphasize the importance of communication and collaboration between clinicians and public health authorities to minimize the health risks of lead in consumer products. "A recent systematic review of lead poisoning case reports identified traditional or herbal medicine as a common cause," the authors wrote. "Heavy metals are sometimes added intentionally because of their therapeutic properties."
"When consumer products may be contaminated with lead, or when lead exposure is associated with community sources, involving public health can facilitate broader actions to reduce and prevent exposure of others at risk," they concluded.