In Vitro Estimation of Lead Content in Nepalese Traditional Ayurvedic Medicines Commonly Used in Children

Address for correspondence Dr. Anil Ojha Assistant Professor, Department of Paediatrics Kathmandu Medical College & Teaching Hospital Sinamangal, Kathmandu, Nepal. E-mail: anilrojha@yahoo.com How to cite this article ? Ojha A. In Vitro Estimation of Lead Content in Nepalese Traditional Ayurvedic Medicines Commonly Used in Children. J Nepal Paediatr Soc 2013;33(2):103-105. In Vitro Estimation of Lead Content in Nepalese Traditional Ayurvedic Medicines Commonly Used in Children


Introduction
I n Nepal before the start of allopathic medicine alternative or complementary medicine was practiced since a long time back.Still this complementary medicine is very popularly used in children.It encompasses treatment with vitamins and mineral supplement, homeopathy, herbal and ayurvedic medicines 1 .It is a common belief that these complementary medicines are safe and non toxic and are dispensed over the counter.Unfortunately this is not always true.Though many of these medicines are used safely there has been recent concern about its toxicity in some of these herbal preparations.The concern is the adulteration of these remedies with heavy metals like lead and arsenic due to poor quality control of the manufacturers of these products.Moreover there can be other toxic substances in these medicines which have not been studied yet.
The most concerning aspect of ayurvedic remedies is its adulteration by lead during its preparation.This is because lead gets absorbed more rapidly in children than in adults.This affects their developing nervous system causing developmental disorder and other side effects.Even low to moderate levels of lead have been associated with deleterious effects in children 2 .Recently there is a report from Reuters Health Information 2012 that the migrated Burmese children from refugee camps in Thailand to United States had dangerously high levels of lead in their blood.Researchers found that these children were given traditional remedies.
Our children from the neonatal period to adolescence are given ayurvedic medicine quite frequently despite of limited studies on the toxicological aspects of these medicines.We intend to address this issue in one aspect by estimating the level of lead level in commonly used ayurvedic medicines in paediatric population in Nepal.

Materials and Methods
This was a cross sectional study.The study period was one month from 1 st October 2012 to 1 st November 2012.Eighteen samples of ayurvedic medicines were selected on their common use in clinical practice and over the counter prescription.The lists of the drugs are given below in Table 1.Table 1: Ayurvedic drugs which were tested for lead content with their manufacture date and batch number.
All the samples were analyzed at Department of Food Technology and Quality Control, Ministry of Agriculture and Cooperatives, Babarmahal, Kathmandu.The samples were encoded 69/CFL/3206 to 69/CFL/3223 and analyzed using Atomic Absorption Spectrophotometer (AAS) 6300.The fl ame mode was used during analysis.Using fl ame mode causes lesser atom excite as compared to graphite furnace analysis (GFA) causing lesser sensitivity in detecting the heavy metals.We used fl ame mode instead of GFA as the latter was not functioning in AAS.
Weighed 1-2 grams of each sample were kept in crucible and heated in a furnace at temperature of 500-600 C. The resulting ash is dissolved in 1:1 dilution of conc.hydrochloric acid and fi ltered and washed with distilled water to obtain a fi ltrate in volumetric fl ask.The fi ltrate is aspirated into the fl ame of AAS.The spectrophotometer analyzed the sample in parts per billion.

Discussion
Alternative medicine is in common practice in country like Nepal.However there are few studies looking at the contamination of these medicines by heavy metals like lead and its potential adverse effect The heavy metals like lead are added to ayurvedic medicines intentionally along with other elements like copper, gold, iron, mercury, silver, tin and zinc.Ayurveda believes that diseases results from imbalance of these elements.This is reason why these elements are added in the remedies.However these minerals are added after they have undergone a 'detoxifi cation' processes 3 .Those who practice ayurveda believe detoxifi cation will make these heavy metals non toxic.This process is done through complex processes, which involves simultaneous heating and cooling of the lead > 30-times in a mixture containing buttermilk, cows urine and a mixture of three plants 4 .Unfortunately this process is unlikely to render heavy metals such as lead nontoxic, although they could infl uence bioavailability if combined with substances that chelated the metals by reducing absorption 3 .
Our study did not detect lead adulteration in those medicines which were selected for the study.This may be because of proper quality control from the concerned authorities assigned for the purpose or it may be the There are many ways of lead intoxication in children.It is least talked about the ayurvedic products as potential source of lead despite its rampant use.The earliest reporting of lead intoxication by the use of aphrodisiacs was in 1978 5 .

Results
Study by Saper RB et al in their study found 20% of ayurvedic herbal medicine products produced in South Asia contained potential harmful level of lead, arsenic and mercury 6 .In a similar kind of study done by Koch I et al, bioaccessible lead was found in in 72% of the 42 samples of traditional Indian medicines 7 .
Study by Jayawardene I et al looking in vitro bioaccessibility of lead, arsenic, cadmium and mercury in fi ve traditional Indian medicine samples was measured as a determinant of bioavailability.When compared with the most liberal published safety guideline, EDAB-Pb (estimated daily amount bioaccessible -lead) in Mahayograj Guggulu and Ekangvir Ras were 37 and 45 fold greater 8 .

Conclusion
There has been an issue of safety of ayurvedic medicines as these can be adulterated with heavy metals like lead.Though our study did not detect lead in the seventeen samples of ayurvedic medicine, a larger study is needed involving large samples of these medicines with use of graphite furnace analysis for testing.It is equally important to make people aware that ayurvedic medicines can be toxic and not always safe as we have reviewed several reported cases of high lead content in these drugs.

Table 1 :
List of ayurvedic products tested for lead

Table 2 :
Test result for lead content in the ayurvedic medicines