Toxicological screening and DNA sequencing detects contamination and adulteration in regulated herbal medicines and supplements for diet, weight loss and cardiovascular health

Crighton, Elly; Coghlan, Megan L.; Farrington, Rachael; Hoban, Claire; Power, Matthew; Nash, Christine; Mullaney, Ian; Byard, Roger W.; Trengove, Robert D.; Musgrave, Ian F.; Bunce, Michael; Maker, Garth

doi:10.1016/j.jpba.2019.112834

Cited by 23 publications

(6 citation statements)

References 22 publications

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“…Other clinicians have speculated that CHS’s etiology stems from contaminants within the cannabis cultivation and production processes 45. The most investigated contaminant is the pesticide azadirachtin, derived from neem oil, which is potentially toxic 46–48. Some clinicians are advising pregnant women to avoid oral consumption of neem oil, as it has been found to be efficacious in pregnancy termination in both rodents and primates 49.…”

Section: Discussionmentioning

confidence: 99%

“…45 The most investigated contaminant is the pesticide azadirachtin, derived from neem oil, which is potentially toxic. [46][47][48] Some clinicians are advising pregnant women to avoid oral consumption of neem oil, as it has been found to be efficacious in pregnancy termination in both rodents and primates. 49 In addition, the producers of azadirachtin characterize the oil as a major irritant to the gut.…”

Section: Discussionmentioning

confidence: 99%

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The Effectiveness of Common Cannabis Products for Treatment of Nausea

Stith

Orozco³

et al. 2021

Journal of Clinical Gastroenterology

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Goals: We measure for the first time how a wide range of cannabis products affect nausea intensity in actual time. Background: Even though the Cannabis plant has been used to treat nausea for millennia, few studies have measured real-time effects of common and commercially available cannabis-based products. Study: Using the Releaf App, 886 people completed 2220 cannabis self-administration sessions intended to treat nausea between June 6, 2016 and July 8, 2019. They recorded the characteristics of self-administered cannabis products and baseline symptom intensity levels before tracking real-time changes in the intensity of their nausea. Results: By 1 hour postconsumption, 96.4% of people had experienced symptom relief with an average symptom intensity reduction of −3.85 points on a 0 to 10 visual analog scale (SD=2.45, d=1.85, P<0.001). Symptom relief was statistically significant at 5 minutes and increased with time. Among product characteristics, flower and concentrates yielded the strongest, yet similar results; products labeled as Cannabis indica underperformed those labeled as Cannabis sativa or hybrid; and joints were associated with greater symptom relief than pipes or vaporizers. In sessions using flower, higher tetrahydrocannbinol and lower cannabidiol were generally associated with greater symptom relief (eg, within 5 min). Conclusions: The findings suggest that the vast majority of patients self-selecting into cannabis use for treatment of nausea likely experience relief within a relative short duration of time, but the level of antiemetic effect varies with the characteristics of the cannabis products consumed in vivo. Future research should focus on longer term symptom relief, including nausea-free intervals and dosing frequency; the risks of consumption of medical cannabis, especially among high-risk populations, such as pregnant women and children; and potential interactions between cannabis, conventional antiemetics, other medications, food, tobacco, alcohol, and street drugs among specific patient populations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Effectiveness of Common Cannabis Products for Treatment of Nausea

Stith

Orozco³

et al. 2021

Journal of Clinical Gastroenterology

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“…Nevertheless, there is also a more recent case, reported in 2018, when there were some unscrupulous manufacturers and distributors who deliberately adulterated jamu through the addition of active pharmaceutical ingredients (APIs)/(Bahan Kimia Obat) (BKO) in order to increase product effectiveness (BPOM-RI 2019). Such adulterations have also been reported for other herbal products worldwide, including, for example, herbal dietary supplements and traditional Chinese medicines (TCM), Indian ayurveda, South African traditional herbal remedies, herbal food supplement on the Dutch market, health products in Canada, and herbal drugs in Iran (Snyman et al 2005;Posadzki et al 2013;Reeuwijk et al 2014;Saberi et al 2018;Crighton et al 2019).…”

Section: Introductionmentioning

confidence: 86%

Risk characterisation of constituents present in jamu to promote its safe use

Suparmi

Wahidin²,

Rietjens

2021

Critical Reviews in Toxicology

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Safety in use of jamu consumption, as part of traditional medicine from Indonesia, is dependent on the complete and adequate assessment of potential hazards and risks of the botanicals and botanical constituents included. This includes especially hazards and risks related to the presence in jamu of active pharmaceutical ingredients (APIs) as well as of constituents that are genotoxic and carcinogenic. The present review presents an overview of the current state-of-the art on these hazards and risks based on case reports on adulteration, and the actual detection of genotoxic and carcinogenic ingredients of concern in jamu. Based on the overview thus obtained, it appears that drug-adulteration presents important hazards responsible for potential adverse effects, due to overdosing. The potential hazards of exposure to APIs mainly relate to the presence of constituents that may cause liver damage, renal impairment, kidney failure, steroid dependence or genotoxicity and carcinogenicity. For these APIs, a risk characterisation was performed based on comparison of health-based guidance values (HBGVs) and exposure, while for the genotoxic carcinogens the margin of exposure (MOE) approach was used. Results of this risk characterisation should be used by risk managers to impose specification for constituents of health concern to protect consumers. It is concluded that to manage the risks identified and further improve the safety in use of jamu, a collaboration between farmers, manufacturer/producers, academia, government, health professionals, and consumers is indicated.

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“…However, the literature reports also safety concerns about natural products. They range from the lack of standardization of natural products, which causes variations in herbal content [ 39 ], misidentification of herbs [ 40 ], contamination during manufacturing or even the presence of undeclared stimulants [ 41 ], to herb-drug interactions [ 16 ]. While a large amount of research has explored consumer risk perception of particular hazards related to food, such as GMOs [ 42 , 43 ], additives [ 44 , 45 ] or pesticides [ 46 ], no study to date has investigated consumers’ risk perception for SBT products, to the best of our knowledge.…”

Section: Theoretical Framework and Hypothesesmentioning

confidence: 99%

Is “Wild” a Food Quality Attribute? Heavy Metal Content in Wild and Cultivated Sea Buckthorn and Consumers’ Risk Perception

Petrescu-Mag

Vermeir

Roba

et al. 2021

IJERPH

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Globally, the consumption of herbal supplements is on an upward trend. As the food supplement industry thrives, so does the need for consumers’ awareness of health risks. This contribution is grounded on two assumptions. Firstly, not always “wild” is a food quality attribute, and secondly, the food chain is judged as a noteworthy route for human exposure to soil contamination. Sea buckthorn (SBT) was selected for investigation due to its versatility. In addition to its wide therapeutic uses, it is present in ecological rehabilitation which may raise concerns regarding its safety for human consumption as a consequence of the accumulation of contaminants in the plant. The study aims to discover if the objective contamination of SBT with toxic residues is congruent with people’s subjective evaluation of SBT consumption risk. A quantitative determination of heavy metals was performed by atomic absorption spectrometry. The metals abundance followed the sequence Fe > Cu > Zn > Mn > Cr > Ni > Pb > Cd. Quantitative data on consumers’ subjective risk evaluations were collected through an online survey on 408 Romanians. Binary logistic shows that the consumption of SBT is predicted by the perceived effect of SBT consumption on respondents’ health. The study confirms that the objective contamination of wild and cultivated SBT is in line with the perceived contamination risk. It is inferred that a joint effort of marketers, media, physicians, and pharmacists is needed to inform consumers about the risks and benefits of SBT consumption.

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Toxicological screening and DNA sequencing detects contamination and adulteration in regulated herbal medicines and supplements for diet, weight loss and cardiovascular health

Cited by 23 publications

References 22 publications

The Effectiveness of Common Cannabis Products for Treatment of Nausea

The Effectiveness of Common Cannabis Products for Treatment of Nausea

Risk characterisation of constituents present in jamu to promote its safe use

Is “Wild” a Food Quality Attribute? Heavy Metal Content in Wild and Cultivated Sea Buckthorn and Consumers’ Risk Perception

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