Heavy metals in some Asian medicines and cosmetics

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Heavy Metals in Some Asian IVied cines and Cosmetics M. Aslam Ph.D. M,P.S,

S. S. Davis Ph.D.M.P.S.

Department of Pharmacy and

M. A. Healy B.Sc. C.chem, M,RJ,C.

Depa~-tnTent ofChemistry, University of Nottingham, University Park, Nottingham NG 7 2RD Significant concentrations of heavy metals have been found in a number of Asian medicines and cosmetics. The herbal baby tonic, Bal Jivan Chamcho contained lead leached from the coating of the spoon with which it was supplied. Some samples of Surma were found to have a lead content as high as 86~o. Amongst other metals, mercury, lead and arsenic were found in the aphrodisiac and tonic Kushtay. A Warak "which purported to be gold was a copper/zinc alloy. No mercury was found in the cosmetic Sandurs and Kum-Kum pastes we examined. but unacceptably high concentrations o f lead and antimony were found in some pills, and o f lead and arsenic in a powder intended for medicinal use. The use of traditional Asian remedies involves a substantial risk o f heavy metal poisoning to which the medical profession should be alerted. Control by legislation alone would not be effective as many of the preparations ar~ sent by relatives in Asia. Introduction Since t950 there has been a marked increase in tile number o f Asian immigrants to the U n i t e d Kingdom, a high proportion c o m i n g from the l n d o - P a k i s t a n sub-continent. W i t h this influx has come n o t only lhe religious and dietary prac6ces o f these peoples, but also their own system o f medicine. We report here some results from our research into the effects o f this. Bal Jivan Chamcho One o f the first Asian preparations we investigated was Bal Jivan C h a m c h o , which was being imported a n d sold through the G r o c e r y trade as a b a b y tonic. In October 1976, a child achnitted t o hospital in Luton with clinical lead poisoning was f o u n d to have been administered regular doses o f this baby tonic. Medicines, such as Bal Jivan C h a m c h o , have been available on the I n d i a n market for m a n y years and in principle appear innocuous. They are c o m p o u n d e d preparations from a 0038-3506179/050274 + 11 $01.00/0

~ 1979 The Society of Community Medicine

HeaL1 hletuls t'tz Sot~l~"Asiean Mredicbles and Cosmetfi's

275

variety of botanical substances; the extracts and a-emainders of which are made into a paste and spread on a spatula-shaped spoon ~nd allowed to dry. The dried preparations, wilh the spoon as a carrier, are then packaged into a small carton, for sale. The label on the container of the Bal Jivan Chamch0 is printed ~n English, Gujera~i and Hindi with tile directions: "'Children Diseases viz Varadha Capiltiary, Bronchitis, Greenish Diarrhoea, Ricke~s. Croup, Convulsions etc. Rubbing the medicine witb~ water o r milk until it gets colour. To be taken twice a d a y . " The herbal preparation is, thus, attov~,ed to soak in :about 5 cm a of milk or waler for several minutes after which the milk is then administered to the child. The preparation itself is not taken but is reused in a similar rraanner for a period of up to seve~! months. Our investigations revealed that when the recommended procedure for administering the medicine was followed, an average dose or 12ppm o f lead was inadvertently given every time the material was used. In addition, the quarttity o f lead ingested increased in proportion to the reuse of the herbal preparation, The plating on the spoon in all the samples we examined was found to show considerable corrosion before the material had been used (Fig. i). This increased with each period of 1use. By using atomic absorption spectroscopy to analyze the compound and the spoon, the results we obtained (Table 1) clearly showed the spoon to be the primary source of contamination from lead. The leaching action into the llerbal preparation was enhanced by addition of moi.~ture which, thus, caused further corrosion and increased solubility of the lead from the spoon. As the high lead content of these herbal medicines was a toxic hazard, particularly in infants, for whose treatment it was recommended, it was proposed that an emergency ordcr prohibiting the import, sale and supply o f these preparations should be implemented. Such an order was made effective from Febrttary 1977 to May 1977 and a permanent order for Bal Jivan Chamcho was introduced in May o f that year.

Snlrlmlt During the course of our studies into the r01e of ihe Hakim (healer) in Asian communities within this country, we became interested in t h e Surma (Fig. 2) which he manufactured for patients. This Surma is applied to the eye, apparently for medicinal purposes, and has the appearance of mascara. However, application is n o t to the outside of the eyelid but to t h e eonjunctival surface (Fig. 3). Its use by Asian families can be traced back ,many centuries. They believe it strengthens and protects the eyes against disease and improves appearance. The Surmas used in our study ranged in col0ur from black, through various shades o f grey to white. From X-ray powder diffraction analysis of an initial batch from 13 different manufaelurers, 11 were found to contaira lead whilst carbon was indicated as the main constituent of the remaining two. More detailed analyses for metals, again using atomic absorption spectroscopy, revealed lead concentrations as high as 86 Yo in the grey surmas which were found to be composed, almost exclusively, of" lead sulphide. Indeed, this material formed the base for the majority ofg~arrnas we have analyzed. Carbon Js added in varying amounts in some compounds, the proportion used modifying the characteristic dark colouration. Various herbs, pearls an,d ~nenthol were also detected, whilst elements present in trace quantities (<0-5 ~o) included iron, copper, zinc, silver, antimony and strontium. In 1976 we became interested :in a 4 year old Asian child who was suffering from lead poisoning. This appeared to be attributable t o the use of a Surma which was found to contain 8 6 ~ lead as lead sttlphide. The ~edical staff a t the hospital of admittance had warned the parents against continuous use of the eye cosmetic but because the child was

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Figure I. Bal Jivan Chamcho showing corroded spoon. TABLE 1.

Analysis of Bal Jivan Chamcho for lead content

Sample

Lead content of spoon (percentage)

Lead content of herbal preparation (ppm)

1 2 3 4

26-5 83.3 32.7 30.1

310 1,040 225 265

a b o y he was the subject of preferential treatment b y his parents. On visiting the home o f this child it became obvious that each time the sample o f Surma was collected from the parents b y the Health Authorities a further sample was immediately forthcoming f r o m anxious grandparents in Pakistan. In addition 'to the usual application o f Surma, it is the c u s t o m with a Moslem child t o place a small dot o f the material on the forehead to ward off the "evil-eye". Because o f the

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Figure 2. A sample of proprietary Surmas.

Figure 3. A decoralive Surma container complete with applicator. superstitious nature o f this child's parents they had also tied ,lengths of blackened string. around his wrists for the same purpose. Their belief was that as a bIack mark is considered a blemish, the combination of the black dot and string would outwit the "'evil-eyed one" and cause him to think the child unattractive.

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In ]97S x~e collected lhrthcr ~amples o f Surma from this child's parents which o11 analysis ~ c : e all found to be o f thc type containing around 867i, lead as lead sulphide. The mother o f the child a d m k t c d that she had continued 'to adminisler Surma on a regular daii 5, basis after the child's releSase from hospital, but asked tha~ lhis information be withheld from her doctor "as hc would ~3t understand". The mean blood-lead levels measured in lhis child were 1976 2.4 pmol/l 1977 3-0 pmol/l 1978 3.4 lamol/l He has now been readmilled to hospital with diagnosed plumbism. In z~ ft~rlher study, car ried out at the Childrens" Hospital, Nottin~:.hzm, measurements were ran.de o f the blood-lead levels in a group o f Asian children mwho"~,vere known tc~ have used Surma and a control group who had .~ol. Ttaewalues obtained gave a mean blood-lead level of 1.6 pmol/l for those children using Surma and 1-0 !Jmol/l for those Asian children who had not had i~e cosmetic regularly applied, l'n his recent paper Joseph ~ comments that 5 o f lhe '82 (6"~,) Asian children for which he measured blood-lead levels had levels in excess o f 1-8 pmol/1. O f the Surma users at N~ltingham. 10 o f the 26"(38~/~i,) had greater thm~ !-8 pmol/l o f lead in'their bloc~.. It is also interesting to note that Dr 2~seph obtei:Jed a value of 1.01amo|/l for his controls on non-Asian children, the same value as in the Noltingham conlrols. It is apparent that these investigations at Nottingham have shown a cle~,r association between blood-lead levels and the use of Surma. Indeed, recently, it was considered that Surma had contribuled to the death due to lead encephalopathy o f a 4-year-old Asian boy in Oldham. Our most recent analyses o f proprietary Surmas sold or imported in the United Kingdora.but manufactured in India or Pakistan areshown in Table2.Thirty-six per cent o f these .o. One sample contained zinc. The use o f menthol had lead concentrations in excess of 50 °/ in Surmas could well exacerbate the risk o f poisoning p.s it causes excessive lachrymalion. TABLE2. Chemiea! analysis of proprietary Surmas sold or brought inlo the United Kingdom but manufactured in India or Pakislan Descriplion

Powder colour

Percentage lead

80"2 53"7

ttashmi Sunna Jowahar Chaharam, Karachi. Surma Moqawi Basar Taj Company, Lahore. Multani, Ayurvcdic 36-H Connaught Circus, Delhi. Nag Jyoti, Murrari Brothers. Delhi.

Grey Grey Grey White

MD Hashim Surma, Bunder Road, Karachi. Bal Jyoti, Murrafi Brothers. Delhi.

Grey Grey-Black

82"9 38"4

Indian Surma, Bhimsaini Kajal with Aela, Murrari Brothers, Delhi. Nargasi Surma, Hamdard, Pakislan, Binger Surma, Harndard, Pakistan. *(Bhimsaini Kajal With Aela.

Cream

Trace

Black Pasle Grey Black

Trace

Trace Trace

(Zinc 4.5 ~ + Menthol)

Black Paste

77-3 26-3 Trace)

Trace = < 0-5 ?~. *Carbon in soft paraffin b~se.

M a n y o f t h e infants we observed responded to the administration o f t h i s type o f Surma with profuse tear formation at which they invariably rubbed their eyes. Inevitably many then sucked their fingers, and hence swallowed the Surma suspended in tears. O f particular

Heavy Metals in Some Asian Medichz~:r aptd Cosmetics

279

concern are the claims made on ttle containers of these Surmas: "'Makes eyes beaulifal and protects eyesight", or "Use Co prevent eye disease and vision defects"'. Despile the evidence against Surmas it is clear their ,~se in immigrant Asian communities remains widespread. Somewhat to our surprise, on a recent random sampling o f 20 homes o f Asian families in Bradford we were able to collect 20 samples of Surmas. After our report on the analysis of Surma samples bought in Bradford and Nottingham a new safety code was announced by the then Prices Minister, M r John Fraser in August 1978. Under these new regulations it will be a criminal offence for cosmetic manufacturers. importers or retailers to m a r k e t any product which is liable to damage health. Our fear. however, is that legislation preventing the sale o f Surrnas will prove ineffective as our investigations indicate that the ~T.aj~rity are obtained directly from abroad by the user. his friends or relatives or the hakim. Kush~a[~,,and Waraks A further group o~ medicines w[dch we have recently examined also give rise to concern. These are fi~,e Kushtay (Fig. 4). The word Kushta is derived from the Persian and means "killed" .or "'conquered". It is applied to these preparations because o f their supposed efficacy at ";killing" or "conquering" the affliction for which they are prescribed. Their composition is mainly oxidized heavy metals including lead, mercury, arsenic, gold, silver and zinc ground together with various herbs. They are prescribed by the hakim as a tonic or as an aphrodisiac. Our study centred in Bradford which is believed to have a high incidence o f nephropathy amongst its Asian population. We wished, therefore, to examine any possible connections this may have with Kushtay.

Figure 4, Some sample Kushtay powders al~d pills.

The preparations of Kushtay are set out in the Hamdard Pharmacopoeia but• our study revealed numerous other formulations listed in texts on Unani and Ayurvedic medical systems. In addition, many of the Hakims in Bradford devised their own Kushtay, and others were produced by individual members o f the community who purchased the ingredients to prepare Kushtay in their homes. Because Kushtay are oftert used as aphrodisiacs and hence are treated in a secretive manner, we recognized that difficulties would be experienced in obtaining a true assessment

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Figure S. A silver Warak. o f the scale o f u s a g e and, hence, the magnitude o f the problem. However, during a 10 m o n t h period we investigated a series o f patients consulting a Hakim a n d / o r attending hospital in Bradford for treatment o f various psychiatric disorders, •Eighty per cent o f the 360 patients we interviewed were male adults and 18+oij,,were female adults, the remainder o f the group were children. From 37 o f the 82 who admitted using Kushtay we were able to collect a sample. All 37 samples were subjected to analysis by X-ray fluorescence and diffraction techniques, in addition to these samples we obtained several Waraks (Fig. 5). Waraks are metal foils, supposedly elemental gold or silver, which are used to adorn sweet meats. They are prescribed for the same purposes as the Kushtay and we have therefore included these in our study. The anal~'tical data we obtained enabled classification o f the samples into four main categories. Eleven samples contained mercury, lead or arsenic as the major constituents with silver, zinc, iron, tin, copper barium and a n t i m o n y present as trace elements. Six K u s h t a y bad major components o f iron, copper and zinc with trace quantities oir tin, manganese and silver, although in two o f these samples the metals were contained only in the coatings o f the pills, the pills themselves being c o m p o u n d e d from herbs. One additional sample which fits into this group was a Warak which purported to be gold but on analysis the colouration was found to be provided by a c0pper/zinc alloy. One sample o f a silver

th'a~ 7" Atetals ht Some Asian Medichms rind Cosmetics

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T,~Bu~ 3. Proprietary names of the KLashtayanalyzed and their source of origin Samt3le names Akseri Gold Warak Jawarish Jalinoos Kushta faulad Kushta faulad mada Kushta gaodanti K ushta jaist K ushta Kali Kushta Khubsul- Hadeed Kushta mirgand Kushta nuqra Kushta para Kushta qalai Kushta sankhia Kushta shangrof Kushta surb Kushla tamba safaid Kushta tamesar Kushla .tamesar Kushta tim kalan Kushta Ilia marwaraidi Kushta zamarrud Kushta indet Kushta indet Kushta indet Maha sudarshan churna Nugra Kushta {Pill) Shaft Silver Warak Kushta Kushta

Dominant element Cu, Zn no heavy metals Fe As Zn As Ire Ag Fe, Hg Sn As (?) As Pb Cu Cu Fe, Cu Hg Calcite and Quartz As Hg Sn, Pb, Hg Ag Ag (coating on pill only) Ag, Fe Zn, Cu no heavy metals (trace Pb) no heavy metals (trace Pb)

Manufacturer~Origin Birmingham Pakistan (note absence of gold ) Bradford Hakim. Bradford Bradford Sheffield, Hakim Hakim, Bradford Hakim, Bradford Hamdard Bradford Home-made, Bradford Hakim, Bradford Home-made, Bradford Hakim, Bradford Hakim, Bradford Hakim, Bradford Hamdard Hamdard Bradford, Hakim Home-made, Bradford Home-made, Bradford ttome-made, Bradford Bradford Zandu, Bombay Hamdard Bradford Bradford

Warak was feund to be pure silver. O f the remaining samples, two were composed o f calcite (CaCO3) and quartz (SiO~) whilst the rest were prepared from organic substaz~ces alone. In two o f the Kushtay containing arsenic, the element was found to be present as As~O~. Table 3 lists the proprietary names o f some o f the Kushtay analyzed together with their source o f origin. Typical formulae are given in Table 4. The cowdung is included not as a drug b u t as a fuel providing heat for the oxidation o f the metals. Because Kushtay are directly ingested they are potentially far more hazardous than Surma. However, it m a y be that the herbs and, indeed, the other metals present irt these preparations, m a y affect the rate o f absorption in the body. It is c o m m o n practice when K u s h t a y are prescribed to advise that they are taken together with an animal oil such as butter (ghee) which m a y also affect the passage o f the metal in the alimentary canal. Irrespective o f these possibilities, it is clear that the use o f K u s h t a y should be discouraged and that much additional w o r k is required in the field o f metal-metal and metal-organic matter interaction. O f particular concern is the presence of As(111) in several samples. From 100-300 mg o f As.~Oa m a y be lethal if absorption is rapid. It is most likely that insufficient heating and time for oxidation was allowed in their preparation; a likely occurrence, particularly with home-made preparations.

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T)~.z 4. Some Lvpical formulae for Kushtay Kushta Mirgang 60 g. 60g. 60 g. 60 g. 6g. 1

Purified mercury (para mu~ffa) Purified fin (qaVai musaffa) Prc~essed sulphur (gandhak amia sar~ Ammonium chloride (naushadar desi) Saltpetrc (shora qalmi) Mica 2 sq. in. {abrak) Soft clay Kushta Para Purified naercury (para mussafa) Purified lead (qal'ai mussafa) l.il,,.ea chine~is, lincly ground (meda iakri ~yida} Symplocos raeemosus finely ground (lodh pathani sayida) Cow-dung pieces (uplay) Large cow-dung pieces (baray uplay do-do kelo kay)

60 g. 60 g. 180 g. 10 kg. 10 kg. 4

Kushta Musallas 250 g. 250 g. 250 g. 750 g. 500 g. I 40kg.

Tin (qal'ail Zinc 0ast I Lead (sin } Saltpetre (shora qalmi) Aloe barbadengis juice (ab ghaikwar] Bamboo pole, 2 yards tong (bans) Cow-dung pieces (uplay) Kushta Sam-UI-Far (Sankhia) White Ar~nic oxide (~m-ul-far) (sankhai safaid) Achyranthes aspera ash (rakh chirehitt.a) Cow-dung pieces (uplay)

60g. + 500 kg. 5 kg. II

II

I

TAm.E 5. Sandurs and Kum-Kum powders and pastes analyzed Material

Colour

Ambar Kajal Shinagar Kumkum Ambar Kumkum tube Joina 13 Colour Kumkum Ambar Kumkum Shrinagar Blue-Green

Orange Orange Blue Blue Red Green

Sandurs and K u m - K e m Pastes Suggestions have been made o f the possible inclusion o f mercury in some Asian cosmetics. 3 These were Sandurs a n d K u m - K u m powders and pastes. Sandurs are used b y Bengali, Bihari or North Indian w o m e n to colour tl, e parting o f the hair whilst the h u s b a n d is alive, K u m - K u m powders and pastes are used as a spot on lhe forehead o f married w o m e n , also only whilst their husband is living. After discussing lhese materials further with the Environmental Health officials in

T^gLE 6. Heavy metal impurities in some Asian medicines Impurities Product name

Major component

Minor component

Khamira gaozaban

Maha sudarshan. Churna powder

Iron

Cogoni oil Bajar, used by men and women (Nicotine) Queen's balm Bala guti pills (useful for Chi|dren's diseases)

TerminalJa chebula powder Pushyanug churna powder

Maximum acceptable 50 ppm. This could cause minor irritation in sensitive individuals. No evidence of the presence of hormones, steroids or aloes. Zn. 168 ppm contained in No evidence of hormones or steroids. 15 % sucrose together with vegetable matter. Titanium, manganese, Essentially soil components zinc, rubidium, strontium presumably derived from the large number of components in the formulation. Iron, zinc. Powder of tobacco.like substance Manganese, iron, zinc, which is rubbed on gums and lead, copper. swallowed. Topical application. Zinc trace ~vt Zinc important. Lead 58 ppm, antimony Lead and antimony too high for infant 750 ppm, arsenic 2 ppm use. (It is used as a cure for calcium deficiency). Iron, zinc, rubidium.

Iron

Titanium, chromium, manganese, nickel, zinc, arsenic, strontium. Zinc, rubidium Iron Iron

Khadiradl pills

Iron

Withania somnifera

Iron

Marayan chun~a

Remarks

zn 13o ppm contained with 41 ~ dextrose and silver particles. Silver

Female fertility stimulant-silver coated Male fertility stimulant, orange brown, pliable mass

Haft taki tablets chandraprapha pills

Trace component

Titanium, manganese, nickel, zinc, arsenic~ strontium, lead.

Lead and arsenic levels unacceptably high in view of the recommended dose 1,1.-4 daily)--maximum intake thus becomes As 4 g, Pb 160g.

Titanium. manganese. copper, zinc, rubidium, strontium. Titanium, manganese, zinc, arsenic (2 ppmL strontium. Manganese. zinc. strontium.

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l~irmingham, x~e conducted our own series o~f analyses on the substances listed in Table 5 using atomic absorption spectrophotometry and X-ray diffraction methods. However, our results did not sho~ the presence o f any mercury in lhe samples we analyzed.

Other Asian Preparations In addition to the materials discussed we analyzed a further range o f Asian medicines which, according to the Pharmacopoeia should have been free from hea~' metals, the only exception to this being the Chandraprapha pills which contain iron. As Table 6 illustrates, lhe materials contained a wide range of heavy metal impurities. Of particular concern are the Bala Guti Pills. which are prescribed (as a children's tonic) in a similar manner to the Bal Jivan Chamchos. In the pills we analyzed we found 58 ppm of lead and 750 ppm o f a n t i m o n y as well as 2 ppm of arsenic. Conclusion Our study is tile tirsl to examine the role of Asian medicines in a Western community The results we reporl here give rise to much concern. At the present time there is considerable public interest centred on the role of lead in petrol and the possible environmental and health hazards which may occur because of this. However, if the lead levels in petrol are compared with the quantity of heavy metals which are regularly being ingested by consumption o f some of the substances we have examined, the need for action becomes obvious. It is our firm belief, however, that legislation is only a partial solution and may, indeed, only serve to drive the problem underground. The prime requirement is for effective communicalion and education to bring about a change in attitude towards the use of these materials within the Asian community. Data we are still collecting indicates that the results we report here are but a small part of a much wider problem. The need for centralization and collation o f this information is, we feel, paramount in order to assist in the treatment o f Asian patients and bring about an awareness o f the special risk to which 'they may be open. References I. Ali, A. R., Smales. O. R. C. & Aslam, M. (1978). British A#edicalJourualii, 915, 2. Josephs, D. S. (1977). Public Health (Lol;don)91, 133. 3. Rao. V, R. (1979). Persona/Communication. Sandwell Area Health Authority.