“I know where you live. I know your address. I know who you are. Trust me, they won’t even find your dead body.”
This threat was not made privately; rather, it was posted on Twitter and addressed to Dr. Abby Philips, who is often assumed to be a white, Hinduphobic woman on a crusade to rid the world of the healing miracle that is Ayurveda. Instead, Dr. Philips (full name: Cyriac Abby Philips) is an Indian man, a doctor who specializes in liver problems and who has, for many years, denounced the harm caused by India’s traditional healing practice.
His raising of the alarm has resulted in court summons, lawsuits, and death threats. What he is exposing is an archaic belief system, interwoven with spirituality, that misunderstands disease and promotes poorly labeled concoctions of herbs, minerals, and bodily excreta.
And these medicinal brews are not well received by the liver, our main detoxifying organ.
The case of the alcoholic teenage liver
If you’re a medical doctor looking for a Holmesian challenge, practicing hepatology in India might be an avenue worth considering. After all, what do you do with a 14-year-old girl whose liver is failing due, apparently, to her being a heavy drinker of alcohol? She was seen by Dr. Philips, and the pathologist who looked at a biopsy of her liver was adamant: it’s the liver of someone who drinks a lot.
The girl, however, credibly denied being a long-time alcoholic. After all, she was 14 years of age. So how did she end up with the liver of someone who consumes over four daily drinks for decades?
After a series of seizures as a child, she was put on antiepileptic drugs, but her family was concerned that maybe she was taking them “in excess.” After all, drugs have a reputation for side effects. They wanted a safer, natural alternative, so they turned to Ayurveda. When her herbal “medications” were analyzed by a laboratory, scientists found that they were adulterated with an actual antiepileptic drug, clonazepam; that they contained volatile industrial solvents; and that they had a cumulative alcohol content of 26% because the herbs were prepared in alcohol tinctures. No wonder her liver was failing.
Ayurveda—which translates to “the science of life”—is a prescientific system of healing from India that is said to have been passed on from the gods to a group of mystics. This oral tradition was captured in three ancient books, which are still used to guide the practice today. I acquired a modern book called Ayurveda: A Holistic Approach to Health by the Ayurvedic clinician Reenita Malhotra Hora, who taught for six years at the University of California, San Francisco, including to medical students. What she describes in the book might as well come from a fantasy novel, as it bears no resemblance to science-informed medicine.
The body is said to possess a life force called ojas, not unlike like the qi of traditional Chinese medicine. Ayurveda recognizes five elements—air, fire, water, earth, and space—and Malhotra Hora writes that “vibrations in space transmit sound,” seemingly unaware of the fact that, as the movie Alien famously reminded us, in space, no one can hear you scream… because sound requires air, and space is devoid of it.
Doshas are created when two of these elements combine, and the way in which the doshas are described reminded me of concepts used in traditional Chinese medicine. Pitta is said to be heating, oily, sharp, and penetrating, and this force is responsible for hormones, intelligence, and body temperature, among other things. If this also conjures up the idea of the four humours theory, you would be right. The Ancient Greek physician Hippocrates described them as blood, phlegm, yellow bile, and black bile—another ancient bid at explaining disease—and Ayurveda similarly posits that whichever dosha (or humour) dominates inside your body will determine your looks and temperament. When vata (made up of air and space) is on top, people tend to be lean and athletic, but when kapha (made up of water and earth) dominates, it brings about calmness and a grounded temperament. Actual biology and psychology, however, have shown these notions to be incredibly simplistic and incorrect.
But in Ayurveda, a dosha imbalance causes symptoms, and this is diagnosed via a number of means, some more questionable than others. Taking a medical history makes sense, but diagnosing a pitta imbalance from greenish, liquid stool has me scratching my head. Ayurvedic practitioners will also measure your pulse, although the book specifies that “each doctor’s approach to pulse diagnosis is very personal, often intuitive, and distinctly different from a pulse examination by a Western doctor.”
The tool bag of Ayurvedic remedies is vast and equally all over the place. It includes meditation and yoga; massages and enemas; medicinal jewelry made of minerals and metals; leeches; herbal tonics; and therapeutic vomiting, in which a bad dosha can be “liquefied” and eliminated through the digestive tract, akin to ancient cleansing rituals in other cultures.
I was lucky enough to watch Dr. Abby Philips give a talk on Ayurveda at QED, a conference on science and skepticism in the north of England, and the screenshots he shared with us of what students—to this day!—are being taught when they study Ayurveda were shocking. For cancer, bloodletting and purgatives are prescribed, as well as a poultice from “excreta of dove and pigeon” to be applied warm on the tumour. Flies will swarm to it and their maggots are said to eat away the cancerous tumour.
Did you know that looking at beautiful women can help treat tuberculosis? Also, if you have diabetes, I hope you have an elephant handy. The beast should be “fed sumptuously” with barley. What then comes out of its rectum is to be added to rice and sweets to make a cake that the diabetic patient will ingest. In a bind, a horse will do.
Pulling back the curtain on Ayurveda can invite racist denunciations of a backwards culture, so let me be clear. Every society stumbles in the dark on its way to understanding how the human body works. Religious notions take center stage, creating oversimplified systems that see a cornucopia of cures in nature. The problem is when these early attempts are not superseded by science, when we get bogged down in tradition and refuse the very real complexities of medicine.
That’s how these belief systems can cause harm in today’s world, and Ayurveda is no exception because many of its preparations are full of heavy metals.
Adding insult to liver injury
The biggest lesson to take from Ayurveda is that just because something is natural or traditional does not make it safe. Nature is replete with harmful substances: poisons, toxins, and metals that, in the right dose, can do a number on our health.
Arsenic, mercury, and lead are commonly detected in Ayurvedic herbal products, in levels that often greatly exceed safety limits. In an analysis of 193 such products from both India and the United States, one in five had detectable levels of these toxic metals. Patients, of course, are not aware that they are ingesting these: Ayurvedic remedies often contain blends of multiple herbs, and their labels, when they exist, are routinely incomplete.
Ayurvedic preparations can cause physical harm for a variety of reasons, including contamination and adulteration with drugs and pesticides due to poor manufacturing practices, but also because some of these herbs naturally contain molecules toxic to the liver, and one herb can interact with another or with a prescription drug to cause liver damage. On average, it takes a little over a month for symptoms like jaundice to appear after these herbs and decoctions are taken daily. As far as we know, these liver injuries are rarely fatal; when they are detected, the liver often heals itself as the Ayurvedic treatment is stopped and the appropriate drugs are given to the patient, although in some cases, a liver transplantation becomes necessary.
Pointing the finger at Ayurveda is difficult, but it can be done by carefully excluding every other possible cause, noticing that liver function returns to normal after cessation of the treatment, and knowing that many Ayurvedic herbs contain molecules known to be toxic to this organ.
Even if you don’t consult an Ayurvedic practitioner, you may be taking some of the very same herbs they would recommend because these plants have made their way into the more secular wellness industry. Ashwagandha is particularly popular, with the world consuming an estimated 7,000 tons of this shrub annually. It is meant to treat and prevent every disease under the sun even though no credible scientific evidence clearly demonstrates any health benefit. Dr. Philips highlights a series of 8 people, mostly men, with liver damage that could be tied to them taking ashwagandha, in preparations that were neither adulterated nor contaminated but that contained the herb’s withanolides, one of which is known to cause DNA damage in cells studied in the laboratory. That is not to say that the herb also known as Indian ginseng is toxic to all; it’s the dose that makes the poison, and some people may be more vulnerable to its effects than others.
In almost all of Dr. Philips’ studies, it’s men who show up to his clinics most often with liver disease associated with the taking of Ayurvedic preparations. It’s not that men gravitate toward these remedies more than women in India, he tells me (the numbers are roughly 50:50); rather, the most dangerous Ayurvedic products are indicated for “wellness and performance” and marketed almost exclusively to men. Men are also referred to specialist clinics like Dr. Philips’ more so than women in India, and men are more likely to drink alcohol. Ayurveda does not only have the power to turn a healthy liver into a diseased one; it can also worsen a liver already challenged by alcoholism. Ayurveda is regularly promoted for use in people who are immunosuppressed, like those with end-stage liver disease whose immune response is disrupted by the illness. These people are particularly susceptible to the liver-toxic effect of many of these preparations.
Kings have long arms
In India, Ayurveda is king. It has its own ministry, Ayush, an acronym that includes ayurveda; yoga; naturopathy; Unani medicine, a traditional healing system of Persian and Arabic descent; Siddha, an ancestral practice in South India and Sri Lanka; and, yes, homeopathy, the pseudomedicine invented by a German doctor in 1796 in which ingredients are often diluted out of existence to cure symptoms. The Ministry of Ayush is even regulated by the Central Council for Indian Medicine, which is distinct from the council that regulates evidence-based medicine. It is a parallel, well-respected, government-protected pseudoscience.
One of the hallmarks of a pseudoscience is its fervent anger at criticism. Dr. Philips, who goes by The Liver Doc online, has suffered abuse for writing up the cases he sees in the clinic in the peer-reviewed medical literature and has had to move his clinic because of threats of physical violence—although he claims that proponents of Ayurveda mainly stick to online abuse; it’s the homeopaths that get violent in the real world, he says, in India, at least.
Doctors need to ask their patients not just about the prescription medication they are on but the herbs and supplements they also take. They are not just placebo pills; they are unregulated drugs. If a popular medication was found to be commonly contaminated with cadmium and lead, action would be taken because drugs are regulated. But when herbal preparations are exempted from scrutiny because we see them as natural or spiritual, we are putting people’s health—and the health of their liver—in harm’s way.
Take-home message:
– Ayurveda is a prescientific healing system from India that is comparable to the four-humour theory of Ancient Greece
– Ayurvedic preparations can include animal dung as an active ingredient
– Many Ayurvedic preparations have been found to contain alarming amounts of heavy metals like arsenic and mercury, which can cause or worsen liver disease