Like many people these days, Lori Potter, a 50-year-old massage therapist living on Kauai, Hawaii, has explored alternative healing for everything from headaches to skin problems. So when she wanted to boost her immune system and lower her stress levels a few years ago, she made an appointment with a visiting practitioner of ayurveda, a medical system that originated in India thousands of years ago and has gained wide popularity in the United States.
He prescribed herbal supplements, which he tested himself for impurities, to help boost her immunity. Soon, Potter said, she felt more energetic and her digestion was better. After two years, the practitioner stopped visiting the island, and she has not taken any supplements since, she said, because she has not met any practitioners she trusts.
"You never know what's really in these supplements," she said. "This is serious stuff, and you can't just take them without knowing the source."
Potter may be right to be wary. A report in the Aug. 27 issue of The Journal of the American Medical Association found that nearly 21 percent of 193 ayurvedic herbal supplements bought online, produced in both India and the United States, contained lead, mercury or arsenic. Almost all of the products were sold through American Web sites. "Some manufacturers advertised that they test for metals, and their products still had them," said Robert Saper, assistant professor at the Boston University School of Medicine and lead author of the study. The average consumer, he said, "has no way of determining which supplement is free of contaminants and which isn't."
No one knows the exact numbers of arsenic, mercury or lead poisoning illnesses in the United States related to ayurvedic medicine. Saper estimated that there have been 80 cases since 1978, but he believes that is just the "tip of the iceberg." In 2005, the Centers for Disease Control and Prevention reported a total of 12 cases of lead poisoning associated with ayurvedic products in Texas, New Hampshire, Massachusetts, New York State and California.
While the Western medical community may be concerned about Saper's findings, many ayurvedic practitioners and holistic health centers are less so. Of the dozen spas, wellness centers and practitioners contacted for this article, all said they stood behind their products. Some suppliers said they believed that the levels of heavy metals in their ayurvedic products were no greater than in many Food and Drug Administration-approved medicines.
Kevin Casey, the chief of Banyan Botanicals, a maker of ayurvedic products in Ashland, Oregon, sells three items — mahasudarshan, shilajit and kanchanar guggulu — that are on Saper's list of contaminated supplements.
After the study came out, Casey said, some of his 15,000 clients, who include practitioners and consumers, called. He said he alleviated their fears after he explained that his products are sent to outside laboratories, and they meet "the standards that we adhere to."
He added that sales had not suffered since the study, which has "created a dialogue — people are talking about it and understanding that there is the presence of heavy metals, but it doesn't mean it's toxic or dangerous."
Saper disagreed. Even with relatively low levels of lead in the bloodstream, he said, "a person can be relatively asymptomatic but the lead can still impact their IQ It can reduce their cognitive function and increase blood pressure."
Michael McGuffin, president of the American Herbal Products Association, a trade group, said that eliminating every trace of arsenic, mercury or lead from products was not a reasonable goal. "If it was, we'd have to find an entirely new food supply," he said.
Many Americans get their first taste of ayurveda at spas. A 2006 survey from the International Spa Association reported that about 31 percent of United States spas offer ayurvedic medicine, usually limited to hot oil massages and facials. But some spas with ayurvedic practitioners, including Exhale in Santa Monica, California; the Chopra Center for Well-Being in Carlsbad, California, and Manhattan; and the Ayurvedic Rejuvenation and Wellness Center in Manhattan, also recommend that some clients take herbal supplements to boost their immune systems and alleviate everything from depression to acne.
Dawne Burrowes, the director of the Ayurvedic Rejuvenation and Wellness Center, said she bought supplements from manufacturers such as Banyan Botanicals, which has been in business for 12 years. The Chopra Center buys some goods from Bazaar of India, an importer of herbal and ayurvedic products in Berkeley, California, and the source of 17 products that Saper found contained lead, mercury or arsenic.
David Simon, the medical director of the Chopra Center for Well-Being, said he was satisfied that Bazaar of India sends its products to an independent laboratory and that the herbs they recommend are free from toxic levels of heavy metals.
John Shahani, the ayurvedic practitioner at Exhale Spa in Santa Monica, took a similar position. Two products sold at the spa made by Balance Ayurvedic Products (AyurRelief and GlucoRite) were found by Saper to contain lead, but Shahani, who is technical director of Balance, said that he had the products tested by American laboratories and was not worried about their safety. "We know everything that goes into our products," he said, adding that he has certificates from the labs to ensure that the products are lead-free.
Kush Khanna, the president of Bazaar of India, defended the safety of the 17 products that Saper listed. All of the items, said Khanna in an e-mail message, have levels of contaminants below the safety levels recommended by the World Health Organization.
Khanna declined to explain why some, but not all, of the offending products are no longer on his Web site. He said business had not suffered since the study was released.
The FDA does not specify maximum acceptable concentrations or daily dose limits for contaminants in dietary supplements. Instead, the onus is on the manufacturer to ensure that its products are safe. What's more, there are no universally accepted standards for herbal supplements. The Food and Agricultural Organization/World Health Organization Joint Expert Committee on Food Additives Secretariat recommends that a 70-kilogram, or 154-pound, person consume no more than 250 micrograms of lead, 50 micrograms of mercury and 150 micrograms of arsenic per day.
The National Sanitation Foundation International Dietary Supplement Standard, which certifies dietary supplements and ingredients for purity, suggests a daily limit of 20 micrograms of lead, 20 for mercury and 10 for arsenic. California Proposition 65 has limits of 0.5 microgram of lead per day and 10 micrograms of arsenic per day. (There are currently no guidelines for mercury.) But, as Wynn Werner, president of the National Ayurvedic Medical Association pointed out, California does not prohibit sales of these products, but "rather requires a specific warning to the consumer if a product contains these elements above its limits." None of the tainted supplements in Saper's study met the standards for lead set forth by California Proposition 65.
In fact, the presence of metals in certain ayurvedic products may be intentional. An ancient form of ayurveda called "rasa shastra" involves fusing organic and mineral compounds — including pearl, gold, diamonds, copper and mercury — into a medicine and then purifying it into what is believed to be a safe and ingestible form. But the rasa shastra products in Saper's study contained the highest levels of mercury, arsenic and lead — as much as 10,000 times over the recommended limits.
Symptoms of lead poisoning, according to Saper, can include abdominal pain, lethargy, impaired cognition, constipation and anemia.
Earlier this year, a woman named Frances Gaskell experienced some of these symptoms after taking Garbhapal Ras, an herbal supplement geared toward pregnant women, and filed a lawsuit in the Federal District Court for the Southern District of Iowa against the manufacturer, Maharishi Ayurveda Products, which is based in India but distributes its products in the United States. According to the lawsuit, her blood levels were over 20 times the level considered safe by the Centers for Disease Control, said her lawyer.
Her case may be among the most extreme, but some spas are wary. Marguerite Barnett, a plastic surgeon, owns the Mandala Med-Spa in Sarasota, Florida A few years ago she added ayurvedic massages to her treatments, but she does not have an in-house ayurvedic practitioner, nor will she sell herbs or supplements. "I am not being negative toward ayurvedic medicine in general — it has a lot to offer — but we do have to raise questions about the purity of the products being used," she said.
Regardless, some are convinced that the benefits outweigh any pitfalls. In her 20's, Gina Simo, now 39 and a full-time mother, suffered from a terrible case of cystic acne. Dermatologists were not able to help her, so she went to the Pratima Ayurvedic Skincare Spa Clinic in Manhattan, run by Pratima Raichur. After three months of dietary changes and herbal supplements, the pimples had disappeared. Simo is undeterred by results of Saper's study, still visits the spa and even gives her 18-month-old daughter supplements for colds and skin allergies. "I just feel so much safer with herbs than with quote-unquote medicine."