title: Is mercury in Tibetan Medicine toxic? Clinical, neurocognitive and biochemical results of an initial cross-sectional study.
abstract: Mercury an important therapeutic substance in Tibetan Medicine undergoes complex "detoxification" prior to inclusion in multi-ingredient formulas. In an initial cross-sectional study, patients taking Tibetan Medicine for various conditions were evaluated for mercury toxicity. Two groups were identified: Group 1, patients taking " Tsothel" the most important detoxified mercury preparation and Group 2, patients taking other mercury preparations or mercury free Tibetan Medicine. Atomic fluorescence spectrometry of Tibetan Medicine showed mercury consumption 130 µg/kg/day (Group 1) and 30 µg/kg/day (Group 2) ( P ≤ 0.001), levels above EPA (RfDs) suggested threshold (0.3 µg/kg /day) for oral chronic exposure. Mean duration of Tibetan Medicine treatment was 9 ± 17 months (range 3-116) (Group 1) and 5 ± 1.96 months (range 1-114) (Group 2) (NS) with cumulative days of mercury containing Tibetan Medicine, 764 days ± 1214 (range 135-7330) vs. 103 days ± 111 (range 0-426), respectively ( P ≤ 0.001). Comparison of treatment groups with healthy referents (Group 3) not taking Tibetan Medicine showed no significant differences in prevalence of 23 non-specific symptoms of mercury toxicity, abnormal neurological, cardiovascular and dental findings and no correlation with mercury exposure variables; consumption, cumulative treatment days, blood/ urine Hg. Liver and renal function tests in treatment groups were not significantly increased compared to referents, with mean urine Beta2Microglobulin within the normal range and not significantly associated with Hg exposure variables after correcting for confounding variables. Neurocognitive testing showed no significant intergroup differences for Wechsler Memory Scale, Grooved Pegboard, Visual Retention, but Group1 scores were better for Mini-Mental, Brief Word Learning, Verbal Fluency after correcting for confounding variables. These results suggest mercury containing Tibetan Medicine does not have appreciable adverse effects and may exert a possible beneficial effect on neurocognitive function. Since evidence of mercury as a toxic heavy metal, however, is well known, further analysis of literature on mercury use in other Asian traditional systems is highly suggested prior to further studies.
authors.affiliation: 1 The Louis L Borick Natural Medicine Research Center, Hadassah Medical Organization, Jerusalem 91120, Israel.
authors.forename: Sarah
authors.initials: S
authors.lastname: Sallon
authors.affiliation: 2 Hebrew University Hadassah, School of Medicine, Jerusalem 9112102, Israel.
authors.forename: Yahav
authors.initials: Y
authors.lastname: Dory
authors.affiliation: 2 Hebrew University Hadassah, School of Medicine, Jerusalem 9112102, Israel.
authors.forename: Yazeed
authors.initials: Y
authors.lastname: Barghouthy
authors.affiliation: 3 Men-Tsee-Khang Tibetan Medical & Astro Institute of H.H the Dalai Lama, Dharamsala, HP 176215, India.
authors.forename: Tsewang
authors.initials: T
authors.lastname: Tamdin
authors.affiliation: 3 Men-Tsee-Khang Tibetan Medical & Astro Institute of H.H the Dalai Lama, Dharamsala, HP 176215, India.
authors.forename: Rigzin
authors.initials: R
authors.lastname: Sangmo
authors.affiliation: 3 Men-Tsee-Khang Tibetan Medical & Astro Institute of H.H the Dalai Lama, Dharamsala, HP 176215, India.
authors.forename: Jamyang
authors.initials: J
authors.lastname: Tashi
authors.affiliation: 3 Men-Tsee-Khang Tibetan Medical & Astro Institute of H.H the Dalai Lama, Dharamsala, HP 176215, India.
authors.forename: Sonam
authors.initials: S
authors.lastname: Yangdon
authors.affiliation: 3 Men-Tsee-Khang Tibetan Medical & Astro Institute of H.H the Dalai Lama, Dharamsala, HP 176215, India.
authors.forename: Tenzin
authors.initials: T
authors.lastname: Yeshi
authors.affiliation: 4 Delek Hospital, Dharamsala, HP 176215, India.
authors.forename: Tsetan
authors.initials: T
authors.lastname: Sadutshang
authors.affiliation: 5 Institute of Toxicology, Tel Hashomer Hospital, Ramat Gan 52621 Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Rotenberg
authors.affiliation: 5 Institute of Toxicology, Tel Hashomer Hospital, Ramat Gan 52621 Israel.
authors.forename: Elinor
authors.initials: E
authors.lastname: Cohen
authors.affiliation: 6 Division of Geochemistry & Environmental Geology, The Geological Survey of Israel, Jerusalem 9550, Israel.
authors.forename: Yehudit
authors.initials: Y
authors.lastname: Harlavan
authors.affiliation: 6 Division of Geochemistry & Environmental Geology, The Geological Survey of Israel, Jerusalem 9550, Israel.
authors.forename: Galit
authors.initials: G
authors.lastname: Sharabi
authors.affiliation: 2 Hebrew University Hadassah, School of Medicine, Jerusalem 9112102, Israel.
authors.forename: Tali
authors.initials: T
authors.lastname: Bdolah-Abram
mesh_terms: D000328:Adult; D003071:Cognition / Q000187:drug effects*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D038861:Medicine, Tibetan Traditional / Q000009:adverse effects*; D008628:Mercury / Q000097:blood / Q000627:therapeutic use* / Q000633:toxicity* / Q000652:urine; D020262:Mercury Poisoning, Nervous System / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D013050:Spectrometry, Fluorescence
chemical_list: D008628:Mercury
keywords: Tibetan Medicine; detoxification; mercury; neurocognitive testing; toxicity