In April 2011, the Iowa Department of Public Health (IDPH) began investigating a cluster of lead poisoning cases in rural Iowa related to Ayurvedic medicines. The State Hygienic Laboratory contributed to the investigation by testing samples of the medicines for heavy metals, and found high levels of lead, mercury, arsenic and other heavy metals in the medications.

Ayurevedic products have been linked to elevated levels of lead, arsenic and mercury.

Don Simmons, Ankeny laboratory manager, co-authored research about the use of Ayurevedics that was published online by the International Journal of Occupational and Environmental Health in March 2018.

The investigation began after a man living in Iowa was identified as having a blood lead level of 93.6 micrograms per deciliter, nearly 10 times the level IDPH defined as elevated in 2011 (10 micrograms per deciliter or greater).

The man reported consuming two Ayurvedic products that he had obtained from a clinic in India. When the State Hygienic Laboratory analyzed the medicines, scientists found lead levels as high as 43,200 parts per million.

Over the next six months, more than 100 adults from the same rural Iowa community who had used Ayurvedic products were tested for blood lead levels. More than 250 samples of the Ayurvedic products were also submitted for heavy metal testing at SHL. Lead was found in 65 percent of samples, and arsenic and mercury were found in over one-third of samples.

Elevated blood lead levels were found in 45 people age 16 and above. Four adults were identified as having elevated blood mercury levels (10 nanograms per milliliter or greater).

According to the National Center for Complementary and Integrative Health, the practice of Ayurvedic medicine originated in India more than 3,000 years ago. It uses a variety of herbal compounds, special diets, medications containing metals and minerals, and other unique health practices.

In the United States, Ayurvedic products are regulated as dietary supplements and, as such, are not required to meet the safety and efficacy standards for conventional medicines. Kathy Leinenkugel, who manages lead poisoning cases in adults for IDPH, reported in her 2011 poster that “consumers and medical practitioners need to be aware of the potential risks and proactively discuss the use of all supplements to determinate the need for testing or intervention.”

The 2011 investigation focused on a specific cluster of cases linked to the consumption of Ayurvedic medicines, but lead poisoning is a wider public health concern in Iowa. According to IDPH, the most common source of exposure for young children is dust or debris from lead-based paint in homes built before 1978. Adults in Iowa with elevated blood lead levels are most commonly exposed to lead in the workplace, while doing home renovation of pre-1978 housing or from hobbies like shooting firearms.

Simmons, who analyzed samples during the 2011 investigation, said that monitoring for lead exposure is particularly important among young children. Children younger than 6 years of age are at higher risk because of increased hand-to-mouth activity, which may lead to ingestion of lead from paint chips or soil, and because of their lower body mass.

Lead harms children’s nervous systems and is associated with reduced IQ, behavioral problems and learning disabilities. Yet, most lead-poisoned children demonstrate no visible symptoms. For this reason, all Iowa children are required to undergo a blood lead test by the age of six years. Through a contract with IDPH, some of this testing is conducted at SHL. Other testing may be conducted by health care providers and local health departments.

Blood lead tests of Iowa residents are reported to IDPH and, when a child with elevated blood lead levels is identified, IDPH or a designated local public health lead program follows up with the child and family as part of the Childhood Lead Poisoning Prevention Program. The program was created to reduce the prevalence of lead poisoning in Iowa by identifying and managing cases for children with elevated blood lead levels, identifying and controlling lead paint hazards, and providing education related to childhood lead poisoning.

When lead poisoning is identified in adults, as in the 2011 investigation, follow up is conducted through the Adult Lead Epidemiology Surveillance Program, which helps employers, workers, medical staff and families learn about the risks of lead exposure in the workplace, community and at home.