associated practice involves chewing betel nuts, with a mixture of areca nut,
lime (calcium hydroxide) and tobacco – known as paan in south-east Asia,
where the practice is most common. The nut produces mild psychoactive
and cholinergic effects, including a copious production of a blood-red saliva
that users spit out. After years of chewing, the teeth may become red-brown
to almost black.^3
In 2009 Papua New Guinea’s cultural obsession with chewing betel came
under threat when the Governor of Port Moresby moved to ban betel nut
chewing in public places, on health grounds.^16
Heavy metals
Mercury,^17 lead^18 and arsenic have been detected in a substantial proportion of
Indian-manufactured traditional ayurvedic medicines and cosmetics.^19 Twenty
per cent of both US-manufactured and Indian-manufactured Ayurvedic medi-
cines purchased via the internet have been shown to contain detectable lead,
mercury or arsenic.^20 Metals may be present due to the practice of rasa shastra
(combining herbs with metals, minerals and gems).
Lead is regarded as an aphrodisiac, and has been used to counteract
impotence in men with diabetes. The following are other examples:
- The product al kohlis applied as an eye cosmetic; its main ingredient is
lead sulphide. - Sumapowders contain over 80% lead and are applied as a cosmetic to
the conjunctival surface of infants and children, from where they may
be transferred to the mouth by the hands. - Sikoris rich in lead and arsenic; it is used as a remedy for indigestion.
Kales et al. compared the relative haematopoietic toxicity of ayurvedic
lead poisoning with a common form of occupational lead poisoning.^21 They
found that ayurvedic poisoning produces greater haematopoietic toxicity
than paint-removal poisoning. Ayurvedic ingestion should be considered in
patients with anaemia. The authors recommend that these patients should
be screened for lead exposure and strongly encouraged to discontinue metal-
containing remedies.
Following a systematic strategy to identify all stores 20 miles or less from
Boston City Hall that sold ayurvedic products, Dr Robert Saper and
colleagues at Harvard Medical School estimated that one of five ayurvedic
products produced in south Asia and available in the area under study
contained potentially harmful levels of lead, mercury and/or arsenic.^22 It is
suggested that users of ayurvedic medicine may be at risk from heavy metal
toxicity, and testing of ayurvedic products for toxic heavy metals should be
mandatory.
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