As COVID Surged, India Had a Silent Outbreak of Giloy-Induced Liver Injury

  • The Indian government has embarked on a no-holds-barred giloy promotion spree in the last two years, through the AYUSH and health ministries.
  • According to doctors, giloy is forbidden for people who suffer from autoimmune disorders, and can lead to death if it is consumed in sufficiently large quantities.
  • But no government agency has warned that people with autoimmune disorders should avoid giloy – a reckless position exacerbated by uncritical media coverage.

New Delhi: The Ministry of AYUSH published a statement on February 16, 2022, on giloy – a plant that features in many Ayurvedic recipes. The ministry, and the Indian government by extension, has widely publicised this herb as an “immunity booster” during the COVID-19 pandemic.

“Certain sections of the media have falsely linked … giloy/guduchi with liver damage,” the ministry statement read. “The Ministry of AYUSH reiterates that giloy/guduchi (Tinospora cordifolia) is safe and as per available data, guduchi does not produce any toxic effect.”

Curiously, there have been no recent media reports criticising giloy. The most proximate event The Wire Science could find was a list of questions The Wire Science had sent to the Ministry of AYUSH, seeking its response to a study that had criticised the willy-nilly consumption of giloy as an “immunity booster”.

Nonetheless, several media outlets reported the statement, many verbatim.

Some people consume the herb raw. Others prefer Ayurvedic ‘preparations’ in the form of capsules, powders or juices. Whenever giloy has propped up in a negative context in the past, the AYUSH ministry has been quick to issue a statement defending it.

The first such release appeared on July 7, 2021. It was responding to a scientific study published in the Journal of Clinical and Experimental Hepatology on July 2. The study revealed that the mindless consumption of giloy was contributing to liver toxicity, specifically drug-induced liver injury (DILI). The study’s findings were based on detailed case studies of six people who had consumed giloy and developed DILI.

According to the study paper:

Tinospora cordifolia (giloy) consumption seems to induce an autoimmune-like hepatitis or unmask an underlying autoimmune chronic liver disease, which may support its immune stimulant mechanism. However, the same mechanism can cause significant liver toxicity, and we recommend that caution be exercised in the use of this herb, especially in those predisposed to autoimmune disorders.”

The government’s immediate reaction was to completely dismiss the study. In its statement, the AYUSH ministry said: “The authors of the study have not analysed the contents of the herb that was consumed by the patients… In fact, there are many studies that point out that identifying the herb not correctly could lead to wrong results. A similar looking herb Tinospora crispa might have a negative effect on the liver.”

That is, the government wanted to know if the authors knew whether the six people had consumed Tinospora cordifolia or Tinospora crispa. The latter is poisonous. The ministry suggested the researchers consult an expert in botany.

It’s a known fact that the two plants are impossible to tell apart with the naked eye. Even Ayurveda experts can’t do so. And both are available in the market, often labelled ‘giloy’.

More than six months after the study was published, The Wire Science spoke to Dr Aabha Nagral, one of the study’s authors and a senior hepatologist

. She said that of the six patients, four had consumed the raw herb: “Our follow-up research has proved that the four consumed Tinospora cordifolia only,” she said.

Dr Nagral also said she and her colleagues will soon be publishing a paper that demonstrates this fact: that the patients in question didn’t consume a known poisonous substance, yet suffered liver toxicity.

“The two others had taken giloy as part of a concoction of immunity-boosting products from two popular companies,” she added. “So legally, those companies couldn’t have mixed the poisonous form.”

Update, November 14, 2022, 10:24 am: Abha Nagral’s findings, which she had shared with The Wire Science in February 2022, were published by the Journal of Clinical and Experimental Hepatology on November 6. A botanical analysis plus other studies confirmed that all their study subjects who had suffered serious liver injuries had indeed consumed Tinospora cordifolia and not Tinospora crispa.

A Hyderabad-based hepatologist also said he has encountered many such patients in the last two years. “Forget about these researchers – do I tell a patient who comes to me with DILI symptoms to bring the herb on the next visit? Even if she does, how am I supposed to distinguish between the two forms?” he asked.

He didn’t wish to be named because he feared reprisal by the Ayurveda industry. “We are trolled on social media. We are served legal notices just for speaking our minds. It is too much trauma to take,” according to him.

Indeed, it wasn’t just the ministry that went after Dr Nagral and her colleagues. The journal’s editor also received numerous letters from Ayurveda medical colleges and companies manufacturing supposedly Ayurvedic drugs.

These included the Patanjali group; the JSS Medical College, Mysore; the State Ayurvedic College, Lucknow; and the All India Institute of Ayurveda, Delhi. They all case doubt on the research paper on various pretexts. The most common argument was “giloy has traditionally proven safe”. The Ayurveda proponents also claimed that a thyroid drug or a fungal infection could have caused the toxicity. The journal published all these responses.

At the same time, many hepatologists reported to the same journal that they were seeing patients with DILI after they had consumed giloy.

Also read: Face It: The Indian Government Is Peddling Pseudoscience

Sandeep Kumar, 32, is a resident of Simariya village in Ambedkarnagar district, Uttar Pradesh. His family of eight consumed giloy as kaadha

during the second wave of India’s COVID-19 outbreak. His father, aged 58, took it everyday, first thing in the morning. He was diabetic and had high blood pressure.

“We had read in a newspaper that giloy was good at preventing coronavirus infections,” Kumar told The Wire Science. “Our neighbours also took it.”

Two months later, his father developed jaundice and was admitted to King George’s Medical University (KGMU), Lucknow, and soon after died there. Doctors told Kumar that his father died due to excessive consumption of giloy.

Kumar is still in a fix about how no one else in the family suffered any adverse events, whereas his father died. The answer is clear: a certain section of the population cannot consume giloy, raw or packaged, doctors said.

“This herb is a strict no-no for those who suffer from any autoimmune disorders, like hypothyroidism or type-2 diabetes,” Dr A.K. Patwa, a doctor at KGMU, told The Wire Science. Sandeep’s father was suffering from the latter.

Autoimmune disorders are those in which the body’s immune system attacks an organ in a way that compromises the organ’s ability to function normally. Dr Nagral’s study pointed to the same contraindications.

(Note: Recent research has suggested that type-2 diabetes could be an autoimmune disease. Hypothyroidism is not an autoimmune disorder but is often caused by one.)

Yet the Indian government has embarked on a no-holds-barred giloy promotion spree in the last two years, with the participation of every official from the AYUSH ministry to the health ministry. The national COVID-19 taskforce chairman Vinod K. Paul has asked people on more than one occasion to consume kaadha and giloy.

In September 2021, the ministry launched a “campaign to distribute prophylactic medicines” against COVID-19. A statement at the time read:

“The kit of Ayurveda prophylactic medicines for COVID-19 contains Sanshamani Vati, which is also known as Guduchi or Giloy Ghan Vati and Ashwagandha Ghan Vati. The kit and the guidelines have been prepared by the Central Council for Research in Ayurvedic Medicines (CCRAS).”

But no government agency has warned that people with autoimmune disorders should avoid giloy – a reckless position exacerbated by uncritical media coverage and advertisements in newspapers and magazines.

Kumar himself is regretful. “My father was very mindful of not consuming anything that would worsen his diabetes,” he said. “We never imagined giloy was harmful to a diabetic.”

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