Case Report: Potential Arsenic Toxicosis Secondary to Herbal Kelp Supplement

Abstract

ContextMedicinal use of dietary herbal supplements can cause inadvertent arsenic toxicosis.Case PresentationA 54-year-old woman was referred to the University of California, Davis, Occupational Medicine Clinic with a 2-year history of worsening alopecia and memory loss. She also reported having a rash, increasing fatigue, nausea, and vomiting, disabling her to the point where she could no longer work full-time. A thorough exposure history revealed that she took daily kelp supplements. A urine sample showed an arsenic level of 83.6 μg/g creatinine (normal < 50 μg/g creatinine). A sample from her kelp supplements contained 8.5 mg/kg (ppm) arsenic. Within weeks of discontinuing the supplements, her symptoms resolved and arsenic blood and urine levels were undetectable.DiscussionTo evaluate the extent of arsenic contamination in commercially available kelp, we analyzed nine samples randomly obtained from local health food stores. Eight of the nine samples showed detectable levels of arsenic higher than the Food and Drug Administration tolerance level of 0.5 to 2 ppm for certain food products. None of the supplements contained information regarding the possibility of contamination with arsenic or other heavy metals. The 1994 Dietary Supplement Health and Education Act (DSHEA) has changed the way dietary herbal therapies are marketed and regulated in the United States. Less regulation of dietary herbal therapies will make inadvertent toxicities a more frequent occurrence.Relevance to Clinical PracticeClinicians should be aware of the potential for heavy metal toxicity due to chronic use of dietary herbal supplements. Inquiring about use of dietary supplements is an important element of the medical history.

Analysis of herbal supplements for selected dietary minerals and trace elements by laser ablation- and solution-based ICPMS

“…Dietary supplements are considered a significant potential source of metal contamination, and supplements at the greatest risk for toxic metal contamination are botanicals (single herb or herb combinations in extract, powder, capsule, or tablet forms) [7,8]. Thus, consumers, especially those that take high doses of supplements often as alternative medicine, may receive overloads of metals over time [7,9].…”

Inorganic elemental compositions of commercial multivitamin/mineral dietary supplements: Application of collision/reaction cell inductively coupled-mass spectroscopy

“…The safety of the multivitamin/dietary supplements depends on various factors including, but not limited to, growing conditions of the raw material and its extraction, formulation, and manufacturing processes (Raman et al, 2004). Several studies documented that these supplementary materials may contain high levels of certain elements, especially Pb and As (Amster, Tiwary, & Schenker, 2007;Mindak et al, 2008) compared to their safe/tolerable exposure levels (provisional total tolerable intake level, PTTI) (Amster et al, 2007;Mindak et al, 2008). Therefore, determining elemental compositions of multivitamin/dietary supplements is crucial.…”

Alopecia and Associated Toxic Agents: A Systematic Review

“…Amster et al [24] described a similar case of a 54-year-old female with alopecia starting a few months after beginning kelp supplements. Other symptoms included memory loss, rash, fatigue, nausea, vomiting, and diarrhea; her urine arsenic level was 83.6 µg/g Cr [24]…”