The Thai tropical plant ma mui, or Mucuna pruriens, was on the public radar last year after Prime Minister Prayut Chan-o-cha urged farmers to grow them instead of rice to cope with drought. The herb recently made newspaper headline again when a 21-year-old woman in the southern province of Trang was found dead earlier this month after taking four capsules of ma mui supplements -- samples she received after becoming a member of a direct-sale business selling the supplement product.
The dose resulted in severe allergic reactions, beginning with a swollen face, rashes and bleeding tongue, ending with visual impairment caused by eye discharge. She was pronounced dead shortly after being sent to a nearby hospital.
The results of the autopsy, now under way, are expected to be released in two months. The mother of the dead woman, who suffered from epilepsy, claimed a sales agent for the direct-sale company said there were no adverse health effects from taking the supplements. That's why they decided to take the capsules, the mother said.
The seeds of Mucuna pruriens have been used for traditional medicine. Chatchai Wattatun
The Foundation for Consumers was quick to come out after the incident, stating ma mui has actually been banned in the production of dietary supplements since February last year based on the Asean Harmonisation on Traditional Medicine and Health Supplements agreement. But the use of ma mui as traditional medicine is allowed in Malaysia, Laos and Myanmar under certain conditions. The foundation, nonetheless, urged Thailand's Food and Drug Administration (FDA) to seize all ma mui supplements available in the general market and wants manufacturers to have better awareness of potential health dangers and to stop selling and advertising their merchandise altogether.
"Consumers purchasing dietary supplements after seeing internet ads are trending now," said Sathaporn Arakwatana, foundation spokeswoman, said in a statement. "The FDA should take action given they are responsible for enforcing food-related law. Websites selling [illegal] products should be closed down because a large number of ma mui supplements sold online is still available. No one stops selling them and they are easily accessible. Some of them are priced at only 30 baht a sachet."
According to Supaporn Pitiporn, a herb expert and chief pharmacist of the Chao Phraya Abhaibhubejhr Hospital in Prachin Buri province, although the unfortunate case of the woman in Trang has once again woken Thai consumers to safety issues of dietary supplements, it also has left them with a lot of questions, especially in terms of the country's health care.
"What is going on with Thailand's universal healthcare system? Many Thais have access to free medical treatments but the question is why do they still seek more alternatives? This shows that people need more than conventional Western health care. They need quality herbs from sources they can trust too," Supaporn said.
Native to Africa and tropical Asia, Mucuna pruriens -- also known as cowage -- has been widely known for being able to cause itchiness when in contact with human skin. But according to Supaporn, the herbal plant has medicinal benefits too. Ma mui reportedly improves erectile function in men. Research has been conducted in India both with lab animals and 20 male subjects. Studies with humans found that the plant was able to increase sperm volume and quality.
Moreover, cowage has also been found to be able to alleviate Parkinson's disease, a degenerative disorder of the central nervous system that affects body movements. The disease itself results from an insufficient production of the brain chemical dopamine. The chemical agent Levodopa, or L-dopa, is converted to dopamine in the brain. And ma mui seeds have been reported to contain L-dopa, making them the light at the end of the tunnel for Parkinson's patients.
Following the recent ma mui supplement case, Supaporn noted the difference between allergic reactions and toxicology of certain herbal plants. An allergy is the body reacting to a foreign substance on an individual basis while toxicology or poisoning refers to health threats posed by certain substances themselves.
For this particular case, the victim has been speculated to have toxic epidermal necrolysis (TEN), the severe, life-threatening version of Stevens-Johnson syndrome (SJS) -- both are dermatological disorders characterised by skin reactions, including skin detachment, and usually caused by a reaction to drugs or chemical agents, especially medication for gout and epilepsy. According to Supaporn, TEN is very rare. The incident rate is only 0.4 to 1.9% of the population.
"The investigation for this case is yet to be conclusive. So we do not even know if ma mui plays a part," said Supaporn. "But what we do know is that it has caused public fear over the use of herbs."
The consumption of cowage these days is mostly in capsule form. But according to the herb expert, the Thai traditional medicine recipe recommends people roast ma mui seeds before grounding them into powder. Ma mui powder can then be mixed with warm water for consumption. People with hypertension should discuss with their doctor if they can take cowage supplements because their blood pressure can potentially be affected. Also the maximum daily dosage of ma mui is 5g, or around a teaspoon.
"When there are cases of people dying from taking unlicensed herbal products, it jeopardises local wisdom," the pharmacist stressed.
"Authorities will come out and say this and that is not right. Why do they not go a bit deeper into the details like if people still want to use the herb, how they should use it properly and safely.
"The direct sale of unlicensed health products should not exist in this country. Right now, Thai consumers do encounter information overload. Advertisements for substandard dietary supplements are available from several unreliable channels. If we do not tackle this issue urgently, a lot more Thai consumers will lose their opportunity to get access to quality treatments."
Supaporn does not treat this just as a health issue. She also labels it a serious public health matter that needs collaborations from all parties involved to sort things out.
"Consumers must be educated and have the strength to choose what's best for them. The academic sector must have better awareness. Mass media must understand it is their mission to provide people with the correct information. Everybody must play a role in setting a standard for the country's health care, not just leave it with Line, Facebook and other social media channels."
Ma mui: What not to do
The consumption of raw ma mui seeds that do not go through any cooking process such as roasting or steaming might cause poisoning. Taking them in an overly large amount is likely to lead to hallucinations, appetite loss and stomach discomfort.
Never take ma mui seeds with monoamine oxidase inhibitors (MAOIs), which are antidepressant drugs. This might cause the blood pressure to rise.
Be careful when taking ma mui with anti-clotting drugs or diabetes medication as well as herbal plants that affect blood clotting such as garlic, gingko and gotu kola (bai bua bok).
Children, pregnant and breast-feeding women should not take ma mui.
Information courtesy of Supaporn Pitiporn
