\u201cI know where you live. I know your address. I know who you are. Trust me, they won\u2019t even find your dead body.\u201d<\/p>\n
This threat was not made privately; rather, it was posted on\u00a0Twitter<\/a>\u00a0and 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\u2019s traditional healing practice.<\/p>\n 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.<\/p>\n And these medicinal brews are not well received by the liver, our main detoxifying organ.<\/p>\n The case of the alcoholic teenage liver<\/p>\n If you\u2019re 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\u00a0a 14-year-old girl whose liver is failing<\/a>\u00a0due, 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\u2019s the liver of someone who drinks\u00a0a lot.<\/p>\n 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?<\/p>\n 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 \u201cin excess.\u201d After all, drugs have a reputation for side effects. They wanted a safer, natural alternative, so they turned to Ayurveda. When her herbal \u201cmedications\u201d 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.<\/p>\n Ayurveda\u2014which translates to \u201cthe science of life\u201d\u2014is 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\u00a0Ayurveda: A Holistic Approach to Health\u00a0by the Ayurvedic clinician Reenita Malhotra Hora, who taught for\u00a0six years<\/a>\u00a0at 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.<\/p>\n The body is said to possess a life force called\u00a0ojas, not unlike like the qi of traditional Chinese medicine. Ayurveda recognizes five elements\u2014air, fire, water, earth, and space\u2014and Malhotra Hora writes that \u201cvibrations in space transmit sound,\u201d seemingly unaware of the fact that, as the movie\u00a0Alien\u00a0famously reminded us, in space, no one can hear you scream\u2026 because sound requires air, and space is devoid of it.<\/p>\n Doshas\u00a0are created when two of these elements combine, and the way in which the\u00a0doshas\u00a0are described reminded me of concepts used in traditional Chinese medicine.\u00a0Pitta\u00a0is 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\u2014another ancient bid at explaining disease\u2014and Ayurveda similarly posits that whichever dosha (or humour) dominates inside your body will determine\u00a0your looks and temperament<\/a>. When\u00a0vata\u00a0(made up of air and space) is on top, people tend to be lean and athletic, but when\u00a0kapha\u00a0(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.<\/p>\n But in Ayurveda, a\u00a0dosha\u00a0imbalance 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\u00a0pitta\u00a0imbalance from greenish, liquid stool has me scratching my head. Ayurvedic practitioners will also measure your pulse, although the book specifies that \u201ceach doctor\u2019s approach to pulse diagnosis is very personal, often intuitive, and distinctly different from a pulse examination by a Western doctor.\u201d<\/p>\n 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\u00a0dosha\u00a0can be \u201cliquefied\u201d and eliminated through the digestive tract, akin to ancient cleansing rituals in other cultures.<\/p>\n I was lucky enough to watch Dr. Abby Philips give a talk on Ayurveda at\u00a0QED<\/a>, a conference on science and skepticism in the north of England, and the screenshots he shared with us of what students\u2014to this day!\u2014are being taught when they study Ayurveda were shocking. For cancer, bloodletting and purgatives are prescribed, as well as a poultice from \u201cexcreta of dove and pigeon\u201d to be applied warm on the tumour. Flies will swarm to it and their maggots are said to eat away the cancerous tumour.<\/p>\n 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 \u201cfed sumptuously\u201d 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.<\/p>\n 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.<\/p>\n That\u2019s how these belief systems can cause harm in today\u2019s world, and Ayurveda is no exception because many of its preparations are full of heavy metals.<\/p>\n Adding insult to liver injury<\/p>\n 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.\u00a0<\/p>\n Arsenic, mercury, and lead are commonly detected in Ayurvedic herbal products, in levels that often greatly exceed safety limits. In\u00a0an analysis of 193 such products<\/a>\u00a0from 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.<\/p>\n 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\u00a0rarely fatal<\/a>; 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.<\/p>\n 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.<\/p>\n Even if you don\u2019t 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\u00a0an estimated 7,000 tons<\/a>\u00a0of 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\u00a08 people<\/a>, 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\u2019s withanolides, one of which is known to cause\u00a0DNA damage<\/a>\u00a0in cells studied in the laboratory. That is not to say that the herb also known as Indian ginseng is toxic to all; it\u2019s the dose that makes the poison, and some people may be more vulnerable to its effects than others.<\/p>\n In almost all of Dr. Philips\u2019 studies, it\u2019s men who show up to his clinics most often with liver disease associated with the taking of Ayurvedic preparations. It\u2019s 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 \u201cwellness and performance\u201d and marketed almost exclusively to men. Men are also referred to specialist clinics like Dr. Philips\u2019 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\u00a0end-stage liver disease<\/a>\u00a0whose immune response is disrupted by the illness. These people are particularly susceptible to the liver-toxic effect of many of these preparations.<\/p>\n Kings have long arms<\/p>\n \u00a0In 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.<\/p>\n 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\u2014although he claims that proponents of Ayurveda mainly stick to online abuse; it\u2019s the homeopaths that get violent in the real world, he says, in India, at least.<\/p>\n 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\u00a0unregulated drugs.\u00a0If 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\u2019s health\u2014and the health of their liver\u2014in harm\u2019s way.<\/p>\n 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<\/p>\n