Alternative drugs go global: possible lead and/ or mercury intoxication from imported natural health products and a need for scientifically evaluated poisoning monitoring from environmental exposures.
BACKGROUND
With increases in globalization, cultural remedies from Chinese, Ayurvedic, Arab and other traditions have become more available to international consumers, offering unfamiliar "Natural Health Products" (NHP), used as alternative medicine or supplementary medicine. Contamination with toxic ingredients including lead, mercury, arsenic, and other toxic elements has been documented in several of these products from various parts of the globe, particularly from some parts of Asia and the Orient.


RESULTS
We have been following this development in the last 6 years and have analyzedn= 20 such products (60 analyses) from patients with intoxication symptoms in a pilot study, showing alarming high concentrations of mercury and/or lead (the first one in "therapeutic" doses). 82 % of the studied NHP contained lead concentrations above the EU limit for dietary supplements. 62 % of the samples exceeded the limit values for mercury. Elevated blood lead and mercury levels in patients along with clinical intoxication symptoms corroborate the causal assumption of intoxication (s). We present one detailed clinical case report of severe lead and mercury intoxications and give an overview about blood concentration related symptoms and signs ofn= 41 case reports of mercury intoxications of the German monitoring BfR-DocCenter.


CONCLUSIONS
For NHP there is evidence on a distinct toxicological risk with alarming low awareness for a possible intoxication which prevents potentially life-saving diagnostic steps in affected cases. In many cases patients do not communicate the events to their physicians or the local health authority so that case reports (e.g. the BfR-DocCentre) are missing. Thus, there is an urgent need to raise awareness and to initiate more suitable monitory systems (e.g. National Monitoring of Poisonings) and control practice protecting the public.
Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, Hamburg, Germany ; European Society for Environmental and Occupational Medicine (EOM), Berlin, Germany ; Occupational Toxicology and Immunology, Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, Marckmannstrasse 129 B, 20539 Hamburg, Germany.
Lygia Therese
LT
Budnik
Charite Institute for Occupational Medicine (CIOM), Charite-University Medicine, Berlin, Germany ; European Society for Environmental and Occupational Medicine (EOM), Berlin, Germany.
Xaver
X
Baur
Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Volker
V
Harth
Federal Institute for Risk Assessment (BfR), Berlin, Germany.
Axel
A
Hahn
Dietary supplements; Heavy metal intoxication; Lead; Mercury; Monitoring; Natural health products; Prevention measures