The Dangers of Self-Medicating with Herbs

by Manju Kolli

Before I had the joy of becoming an Ayurvedic Practitioner, I trained and served as a clinical pharmacist. My experience in pharmacy, spanning more than 15 years, has both informed and enriched my perspective on the Ayurvedic practice I have built.   

As a pharmacist, one of the most alarming and challenging trends I have witnessed is the surge in sales of over-the-counter (OTC) drugs, particularly those designed to alleviate symptoms of a range of increasingly common chronic illnesses. The growing use of OTC medications has been further fueled by their affordability, as well as by a rise in the number of prescription drugs that are now available over the counter.   

Abuse and overuse of OTC medications can have serious consequences. The dangers from misuse of certain OTC painkillers, cough medicines, antihistamines, antacids, and laxatives, for example, are well documented within the medical community, and there is growing public awareness of the perils as well. 

We are now seeing rising sales of herbal supplements, the market for which is currently valued in the multibillion dollar range and continuing to grow as increasing numbers of consumers seek natural remedies, both to prevent disease and to address chronic conditions. Additionally, the COVID-19 crisis is prompting many wellness consumers to look to supplements, including herbs, to boost their immune system.

Given my overlapping backgrounds in pharmacy and Ayurveda, I am acutely aware of the dangers of potential misuse of herbal supplements by consumers who may be self-medicating. This concern is shared by Ayurvedic and allopathic doctors alike. A friend who is a nephrologist even made a personal appeal to me to help save people’s kidneys by warning them of the dangers that lie in the misuse of herbal supplements.

The Science of Herbs

Although those of Indian origin tend to see Ayurveda as grandma’s wisdom-infused medicine, the reality is that Ayurveda is highly scientific in its approach to health and wellness. The well-developed rationales and principles underlying this approach and the logical treatment protocols it comprises have withstood the test of time. 

Foundational to Ayurveda is the understanding that we all have a distinct blueprint at birth. As we mature, age, and go through life’s varied experiences and challenges, the natural balance of our original constitution (prakruti) changes and can be pushed out of balance. This imbalanced state (vikruti) is heavily influenced by our dietary and lifestyle choices. 

Since a person responds to external triggers according to their particular prakruti, one person’s medicine can be another’s poison. This insight is true for most herbs just as it is true for most drugs.

Also essential to the proper use of herbs is a clear understanding of the Ayurvedic principle Karya Karana Bhava, which holds that no event occurs in creation without a cause. Simply put, there is a cause behind each and every disease. Ayurveda’s wisdom is used to address that cause in order to maintain health, prevent disease, and restore balance. 

Let us look at the common problem of indigestion. One study cited by the National Institute of Health estimates that one in four Americans suffers from it. 

There are many causes of indigestion. I have grouped together some common causes according to the dosha they can aggravate:

1. Excessive or high-impact physical activity or insufficient food consumption, aggravating vata

2. Spicy, salty, or sour foods, or excessive anger, aggravating pitta

3. An extremely sedentary lifestyle or consumption of too many sweet and heavy foods, aggravating kapha 

Trikatu (which comprises dry ginger, black pepper, and pippali) can be very helpful in curing indigestion, as well as the bloating it can cause; however, it is only truly applicable to one of the three scenarios listed above.

In the first scenario, indigestion is likely to have resulted from insufficient digestive fire because of a loss of tissue strength, with the influence of vata’s predominantly dry and light properties. Trikatu will increase these depleting qualities, due to its own inherent dry and light properties, which, in turn, will aggravate the indigestion.

In the second scenario, indigestion results from excessive pitta, and trikatu will likewise aggravate indigestion and pitta due to its hot potency.

In the third scenario, however, trikatu is indicated as an appropriate pacifying remedy. 

Here are some other examples of commonly available herbs that are subject to misuse: 

Tulsi is known for helping with cold and cough symptoms. If, however, a cough is due to depletion, and it is dry, tulsi will increase the dryness and depletion and could aggravate the cough.

Ashwagandha is frequently used to treat depression, help with fertility, and increase muscle mass. If a client’s symptoms are due to excess accumulation of ama (undigested food in the body), however, ashwagandha will only worsen the condition. 

Triphala is definitely an amazingly versatile herbal medicine that can help in many scenarios, but long-term use of it can create a harmful dryness in mucosal linings. 

Neem can help with diabetes by removing excess accumulation of mucus. Yet if neem is overused after it achieves the desired action, vata gets aggravated, creating an imbalance.

Even ghee, one of the most widely advocated superfoods in Ayurveda, can be misused. If a person is suffering from insufficient digestive fire (mandagni) and excessive mucus, ghee can further dampen digestion and exacerbate the problem. 

These are but a few examples of why it is essential to understand the nature of both the prakruti and the vikruti of clients, as well as the pathological road map of their disease manifestation, before prescribing herbal treatments. It is also important to use the optimal delivery method, including the Karya Karana Bhava, that will efficiently and effectively deliver the right herb to the right site and body system. 

As these examples illustrate, well-meaning friends can naively advocate for an herb that has worked very well for them but can be harmful for someone else. In contrast, a knowledgeable Ayurvedic Practitioner can help clients find and correctly use herbal supplements that are right for them.

Our Role in Educating the Public

As Ayurvedic Practitioners, we play a critical role in protecting public health. Here are three suggestions for increasing awareness of the benefits of herbal supplements and the dangers of self-medicating:

1. Ask your clients to reach out to you with any questions rather than try to self-medicate based on advice from friends or information they find on the internet.

2. Offer free talks in public venues, such as virtual or live forums hosted by local libraries.

3. Author articles for local newspapers to educate your community.

The increasing popularity of herbal supplements and remedies represents a potential turning point in public awareness and medical community acceptance of Ayurveda as a credible pathway to health and wellness. It is up to us as practitioners and students of Ayurveda to help people understand that herbs and herbal supplements must be used appropriately.

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About the Author

Manju Kolli is an Ayurvedic Practitioner based in California’s Bay Area, where she is the founding director of Ayurhitam, an Ayurvedic wellness clinic. Manju has more than 15 years of experience serving as an allopathic clinical pharmacist at the long-term care pharmacy PharMerica. A NAMA-recognized Ayurvedic Practitioner, she also teaches Ayurveda and has expertise in women’s and children’s health, gut problems, skin conditions, mental health, and allergies.

NAMA Responds to Issue of Heavy Metal Toxicity

National Ayurvedic Medical Association (USA)
Ayurvedic Practitioners Association (UK)
Verband Europäischer Ayurveda-Mediziner und -Therapeuten (Germany)

Joint Response to the August 2008 JAMA Article

A study conducted “to determine the prevalence of Ayurvedic medicines available via the Internet containing detectable lead, mercury, or arsenic” has concluded that “one-fifth of both US-manufactured and Indian-manufactured Ayurvedic medicines purchased via the Internet contain detectable lead, mercury, or arsenic.” The article can be found in the August 27 issue of JAMA, the Journal of the American Medical Association (Vol 300, No.8 p915) titled “Lead, Mercury, and Arsenic in US- and Indian-Manufactured Ayurvedic Medicines Sold via the Internet.”

The National Ayurvedic Medical Association (NAMA), Ayurvedic Practitioners Association (APA) and Verband Europäischer Ayurveda-Mediziner und -Therapeuten (VEAT) welcome all efforts to enhance quality and safety of Ayurvedic products but recommend that this study be interpreted with caution. We recognize and support the need for effective quality control in the use of all Ayurvedic products and promote the use of suppliers who use Good Manufacturing Practices. We agree that there is clearly a challenge with heavy metals throughout the food chain as a whole.

“Metals,” “heavy metals” and “toxic metals” are all terms used for a group of elements which include lead, mercury, arsenic and others that are known or suspected to cause toxicity in certain forms and at certain doses. The detectable presence of these elements in dietary products and food or water is not the same as toxicity. These elements are present in many of our everyday foods and as shown in this study, Ayurvedic dietary supplements. In the case of foods and herbal products their presence can occur because: 1) they are naturally occurring in the soil, water and air, 2) from pollution as a result of human activity where in both cases theses elements are taken up by the plants, 3) from contamination in the manufacturing process, and 4) these elements are intentionally added. Toxicity is the result of too much of the specific form of metal being ingested over time.

In the U.S, there is no current national law precisely regulating the amount of lead, mercury and arsenic in dietary supplements. There are various opinions on what the maximum safe daily limits for lead, mercury and arsenic in dietary supplements should be. For example, four authorities are, mentioned in the JAMA article and their limits vary considerably. They are: the California Safe Drinking Water and Toxic Enforcement Act (California Proposition 65) that gives a maximum level of 0.5 μg /day for lead as a reproductive toxin; The American National Standards Institute (ANSI)/National Sanitation Foundation (NSF) International Dietary Supplement Standard 173 that gives a maximum level for lead at 20 μg /day, mercury at 20 μg /day and arsenic at 10 μg /day; the US Environmental Protection Agency (USEPA) that gives a maximum level of 21 μg /day for inorganic mercury and 21 μg /day for inorganic arsenic for a 70 kg adult; and The Food and Agricultural Organization / World Health Organization Joint Expert Committee on Food Additives (FAO/WHO) that give total dietary intake maximum levels of 250 μg /day for lead, 50 μg /day for mercury and 150 μg /day for arsenic for a 70 kg adult. In the absence of specific standards it is difficult for the dietary supplement industry and Ayurvedic community to know what limits to meet. NAMA, APA and VEAT welcome government guidelines for the industry. [μg = mcg = micrograms or one millionth of a gram = 0.000001 sometimes referred to as ppm or parts per million -- mg = milligrams or one thousandth of a gram = 0.001]

The JAMA article states that “one-fifth of both US-manufactured and Indian-manufactured Ayurvedic medicines purchased via the Internet contain detectable lead, mercury, or arsenic.” However, as discussed above, the simple presence of any of these elements does not in and of itself translate to toxicity. This “one-fifth” (or 20%) was based simply on whether lead, mercury or arsenic was able to be detected in the product, not the specific forms of these metals that are of concern and without consideration of the resulting daily dose. More importantly, all these products were said to “cause ingestions exceeding at least 1 regulatory standard.” The “regulatory standard” with the lowest levels is California’s Proposition 65, with a maximum level of 0.5 μg /day; the lowest by far of all of the limits cited in the article and one that does not take into consideration naturally occurring lead. It is important to note that California Proposition 65 is not a regulation prohibiting sales of these products, but rather requires a specific warning to the consumer if a product contains these elements above its limits. If a different analysis were done using the daily dose limits of ANSI/NSF, USEPA and FAO/WHO, we would find that the percentage of products containing heavy metals and resulting in daily doses above their recommended amounts is approximately 8% of total products, not the 20% stated in the article.

There is one more important issue to consider. Among the products tested, there were some traditional Ayurvedic products that intentionally contain specially prepared forms of lead, mercury and or arsenic. Although these products have been in use in India for hundreds of years with claims of efficacy and safety, they have not been proven by modern medical science to be either safe or effective. NAMA, APA and VEAT recommend that practitioners and consumers should avoid the use of products in which lead, mercury and or arsenic have been intentionally added until these products are better understood by modern science and medicine, and there are clear guidelines both from within the Ayurvedic community and national laws. Finally, if we were to count only those products that do not have lead, mercury or arsenic intentionally added but would still result in daily doses above the authorities other than California Proposition 65, we find about 5%, not “one fifth” 20%.

In order to adequately and effectively meet the existing challenge of heavy metal contamination in Ayurvedic products, NAMA, APA and VEAT make the following recommendations:

1.  That government and industry establish sound, scientific daily dose limits for lead, mercury and arsenic in all dietary supplements and establish Good Manufacturing Practices that all manufacturers demonstrate compliance through independent third-party testing using validated preparation and testing methodologies, not just for Ayurvedic products and dietary supplements but also for conventional foods.

2. That manufacturers, marketers, practitioners and consumers of herbal products stop importing, manufacturing, distributing, selling, recommending and using any product for which lead, mercury or arsenic have been intentionally added until such time as modern western science and medicine have proven the safety of such products.

3. We support those companies who adhere to the points in these recommendations, Good Manufacturing Practices, quality control and who are members of one or more recognized industry associations that are committed to safety and quality.

4. Until such time as government and industry can agree upon and establish scientifically sound daily dose limits for lead, mercury and arsenic, we recommend that manufacturers and practitioners adhere to any government regulations currently in existence and at a minimum follow the lower of the guidelines established by ANSI/NSF and FAO/WHO which are currently 20 μg /day for lead, 14 μg /day for mercury and 10 μg /day for arsenic. Consumers must make their own decisions on what is safe for them based on sound scientific, medical and expert advice according to their own personal situation.

NAMA-APA-VEAT Joint Response to JAMA Article on Heavy Metals in Ayurvedic Medicines - September 2008