This week’s “The Scientist” has an interesting detective story about searching for the cause of the “black houses of Croatia”.

It sounds like a scary Halloween story, but it’s not. It’s a story about the dangers of herbal medicine, and how scientists are finding the reason for unexplained deaths in the Balkans that have been going on for centuries, and finding links between these deaths and the deaths of Belgians from a Chinese weight loss herbal supplement.

Herbs are not always safe, and although most Americans use various “over the counter” medicines, including herbs and supplements, usually we docs don’t get a list of them in our history unless we recognize that it is a problem.

Luckily, most people take smaller doses on and off, not huge doses, so the risk is minimal. But every once in awhile the supplements cause a disease that takes awhile until docs figure out the cause.

So this week’s “The Scientist” has a nice article pulling together the problems of a common plant that is widely used in Chinese herbal medicine: Aristolochia.

A couple years ago, there had been a report that a Chinese Herb caused cancer of the kidney/urinary tract.

But my patients didn’t use Chinese herbs, so I ignored the part about kidney disease (most of the end stage kidney disease we treated was from Diabetes or Lupus).

But it seems that the herb is widely used in Chinese medicine for weight loss, and that back around the year 2000 there were reports that over 100 people in Europe who had used various Chinese herbs to lose weight had developed kidney failure (end stage Renal disease) from interstitial fibrosis.

The FDA has since then banned any medicine that had the suspected herb/chemical, but of course one of the dangers of China is that due to corruption, what is listed on the ingredients might not be what is actually inside. Years ago, we had an epidemic of problems from Chinese herbal medicine for arthritis that contained either Prednisone or Indocin.

The interesting thing is that there is a link between this type of renal failure and a type of familial kidney failure and death in the Balkans that according The Scientist is probably due to families eating bread from their own fields, which have the herb growing as a weed.

It is also being investigated if certain family genes make one more sensitive to the toxic side effects of the herb.

The herb Aristolochia is widely used in herbal medicine all over the world,

Aristolochia clematitis growing in a wheatfield outside the endemic village of Kaniža.
© Mirko Beoviće /

Greek and Roman pharmacopeias of the 4th century BC contain Aristolochia-based remedies for asthma, gout, and bladder stones. Ancient Coptic and Arabic recipes date back to 900 AD. The use in traditional Chinese medicine was first recorded in the 3rd century AD. Native Americans believed A. serpentaria, commonly called Virginia Snakeroot, could cure snakebites and other wounds.

Today, Chinese herbal practitioners mix A. fangchi into weight-loss supplements, prescribe A. manshuriensis as a diuretic, A. heterophylla for asthma, and A. debillis to suppress coughs.1 Practitioners in India, Japan, and Sudan use Aristolochia plants, too. The United States and a few other countries now ban the import of those supplements, but seeds, roots, and supplements are available over the Internet. Every single part of the plant – the leaves, roots, seeds, and stalks – and every Aristolochia species is poisonous.

The Scientist article mentions that this herbal toxicity is suspected of causing much of the interstitial nephritis in some parts of Asia.

However, with globalization making a lot of people in Asia fat and prosperous, I worry that unregulated “weight loss” mixtures with the ingredient might be a time bomb for an epidemic of renal failure in many Asian countries.

And the mention of “Virginia snakeroot” worries me, because this is a known herbal remedy for Native Americans and widely used in herbal medicine.Some of my Native American patients collected and used it (although none used high doses or developed kidney problems).
So this is an ongoing story…and a reminder that living a “Natural” life has it’s own dangers of being poisoned.

Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket, and she writes medical essays at HeyDoc Xanga blog.

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