{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T14:36:33Z","timestamp":1790865393629,"version":"4.1.0"},"reference-count":23,"publisher":"American Chemical Society (ACS)","issue":"4","license":[{"start":{"date-parts":[[2017,12,29]],"date-time":"2017-12-29T00:00:00Z","timestamp":1514505600000},"content-version":"vor","delay-in-days":3998,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2007,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Medicinal use of dietary herbal supplements can cause inadvertent arsenic toxicosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>A 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 \u03bcg\/g creatinine (normal &amp;lt; 50 \u03bcg\/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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>To 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance to Clinical Practice<\/jats:title>\n                    <jats:p>Clinicians 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1289\/ehp.9495","type":"journal-article","created":{"date-parts":[[2007,1,18]],"date-time":"2007-01-18T15:37:32Z","timestamp":1169134652000},"page":"606-608","source":"Crossref","is-referenced-by-count":65,"title":["Case Report: Potential Arsenic Toxicosis Secondary to Herbal Kelp Supplement"],"prefix":"10.1021","volume":"115","author":[{"given":"Eric","family":"Amster","sequence":"first","affiliation":[{"name":"School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asheesh","family":"Tiwary","sequence":"additional","affiliation":[{"name":"School of Veterinary Medicine, University of California, Davis, California, USA"},{"name":"California Animal Health & Food Safety Laboratory System, Davis, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc B.","family":"Schenker","sequence":"additional","affiliation":[{"name":"School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"316","published-online":{"date-parts":[[2007,1,18]]},"reference":[{"key":"2026080608101366100_micit1","author":"Agency for Toxic Substances and Disease Registry"},{"key":"2026080608101366100_micit2","author":"[Anonymous]"},{"issue":"2","key":"2026080608101366100_micit3","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/0048-9697(81)90056-5","article-title":"Exposure of man to environmental arsenic\u2014an exposure commitment assessment","volume":"20","author":"Bennett","year":"1981","journal-title":"Sci Total Environ"},{"key":"2026080608101366100_micit4","author":"Dietary Supplement Health and Education Act of 1994"},{"issue":"12","key":"2026080608101366100_micit5","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1056\/NEJM199509213331217","article-title":"Arsenic and mercury in traditional Chinese herbal balls","volume":"333","author":"Espinoza","year":"1995","journal-title":"N Eng J Med"},{"key":"2026080608101366100_micit6","author":"Federal Food, Drug and Cosmetic Act of 1938"},{"issue":"1","key":"2026080608101366100_micit7","first-page":"146","article-title":"Pesticides, selected elements, and other chemicals in adult total diet samples, October 1980\u2013March 1982","volume":"69","author":"Gartrell","year":"1986","journal-title":"J Assoc Off Anal Chem"},{"issue":"9","key":"2026080608101366100_micit8","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1056\/NEJM195603012540901","article-title":"Peripheral neuropathy caused by arsenical intoxication; a study of 41 cases with observations on the effects of BAL (2, 3, dimercapto-propanol)","volume":"254","author":"Heyman","year":"1956","journal-title":"N Engl J Med"},{"issue":"5","key":"2026080608101366100_micit9","doi-asserted-by":"crossref","first-page":"451","DOI":"10.3109\/15563658608992607","article-title":"Arsenic content of homeopathic medicines","volume":"24","author":"Kerr","year":"1986","journal-title":"J Toxicol Clin Toxicol"},{"issue":"23","key":"2026080608101366100_micit10","doi-asserted-by":"crossref","first-page":"1742","DOI":"10.1056\/NEJM200006083422309","article-title":"Cancer and herbs","volume":"342","author":"Kessler","year":"2000","journal-title":"N Engl J Med"},{"issue":"12","key":"2026080608101366100_micit11","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1056\/NEJM199809173391214","article-title":"Adulterants in Asian patent medicines","volume":"339","author":"Ko","year":"1998","journal-title":"N Engl J Med"},{"issue":"25","key":"2026080608101366100_micit12","doi-asserted-by":"crossref","first-page":"2073","DOI":"10.1056\/NEJMsb022858","article-title":"Botanical medicines\u2014the need for new regulations","volume":"347","author":"Marcus","year":"2002","journal-title":"N Engl J Med"},{"issue":"2","key":"2026080608101366100_micit13","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1080\/02652030500316959","article-title":"Lead content of dietary calcium supplements available in Brazil","volume":"23","author":"Mattos","year":"2006","journal-title":"Food Addit Contam"},{"issue":"6","key":"2026080608101366100_micit14","doi-asserted-by":"crossref","first-page":"A378","DOI":"10.1289\/ehp.113-a378","article-title":"Arsenic: in search of an antidote to a global poison","volume":"113","author":"Mead","year":"2005","journal-title":"Environ Health Perspect"},{"issue":"3","key":"2026080608101366100_micit15","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1177\/096032719000900314","article-title":"Herbal medicine as a cause of combined lead and arsenic poisoning","volume":"9","author":"Mitchell-Heggs","year":"1990","journal-title":"Hum Exp Toxicol"},{"issue":"23","key":"2026080608101366100_micit16","doi-asserted-by":"crossref","first-page":"2868","DOI":"10.1001\/jama.292.23.2868","article-title":"Heavy metal content of ayurvedic herbal medicine products","volume":"292","author":"Saper","year":"2004","journal-title":"JAMA"},{"key":"2026080608101366100_micit17","author":"Schoof"},{"key":"2026080608101366100_micit18","author":"Smedley"},{"key":"2026080608101366100_micit19","first-page":"79","article-title":"Environmental biochemistry of arsenic","volume":"124","author":"Tamaki","year":"1992","journal-title":"Rev Environ Contam Toxicol"},{"issue":"11","key":"2026080608101366100_micit20","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1080\/026520399283759","article-title":"Dietary arsenic intakes in the United States: FDA total diet study, September 1991\u2013December 1996","volume":"16","author":"Tao","year":"1999","journal-title":"Food Addit Contam"},{"issue":"11","key":"2026080608101366100_micit21","doi-asserted-by":"crossref","first-page":"424","DOI":"10.5694\/j.1326-5377.1975.tb105939.x","article-title":"Arsenic poisoning from anti-asthmatic herbal preparations","volume":"2","author":"Tay","year":"1975","journal-title":"Med J Aust"},{"issue":"3","key":"2026080608101366100_micit22","first-page":"516","article-title":"Continuous flow vapor generation for inductively coupled argon plasma spectrometric analysis. Part 2. Arsenic","volume":"74","author":"Tracy","year":"1991","journal-title":"J Assoc Off Anal Chem"},{"issue":"3","key":"2026080608101366100_micit23","doi-asserted-by":"crossref","first-page":"325","DOI":"10.3109\/15563657508988081","article-title":"Health food supplements prepared from kelp\u2014a source of elevated urinary arsenic","volume":"8","author":"Walkiw","year":"1975","journal-title":"Clin Toxicol"}],"container-title":["Environmental Health Perspectives"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/pubs.acs.org\/evhpaz\/article-pdf\/115\/4\/606\/66436845\/ehp.9495.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/pubs.acs.org\/evhpaz\/article-pdf\/115\/4\/606\/66436845\/ehp.9495.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T13:56:12Z","timestamp":1786629372000},"score":1,"resource":{"primary":{"URL":"https:\/\/pubs.acs.org\/evhpaz\/article-lookup\/doi\/10.1289\/ehp.9495"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2007,1,18]]},"references-count":23,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2007,1,18]]},"published-print":{"date-parts":[[2007,4,1]]}},"URL":"https:\/\/doi.org\/10.1289\/ehp.9495","relation":{},"ISSN":["0091-6765","1552-9924"],"issn-type":[{"value":"0091-6765","type":"print"},{"value":"1552-9924","type":"electronic"}],"subject":[],"published":{"date-parts":[[2007,1,18]]}}}