The Centres for Disease Control received a report of elevated blood lead levels in an adult which was attributed to an Asian remedy for menstrual cramps (“Koo Sar” pills) following an investigation by the Adult Lead Registry of the Connecticut Department of Public Health (CDPH), Division of Environmental Epidemiology and Occupational Health.

A Cambodian woman, her husband and their two children were screened at a free lead-screening event sponsored by a nursing school community health promotion. The husband and children were found to have normal blood lead levels. However, the woman had a blood lead level of 44 micrograms/decilitre, which was confirmed by another test two weeks later (42 micrograms/decilitre). She reported no symptoms associated with lead poisoning (e.g. muscle pains or weakness, headaches, or loss of appetite).

The CDPH coordinator requested samples of any medicines, teas or cosmetics that the woman had used that might have been the source of the lead. Lead was found only in bottles of red pills, at concentrations of 3.5 ppm from one bottle and 1.2 ppm in a second bottle.

Investigation revealed that for 3-4 years the woman had taken six of these pills per day on 7 days of each month to treat menstrual cramps. She was advised to stop taking the pills and was asked to submit additional pills for further investigation. Follow-up blood lead levels dropped from 28 micrograms/decilitre to 12 micrograms/decilitre over a period of six months.

Further laboratory analysis of the pills showed lead in amounts of 12.5 ppm in pills from one bottle and 4.5 ppm in pills from a second bottle. The source of the pills was traced to a San Francisco-based Hong Kong company where the pills were sold in packages with the brand name listed on the outside of the package as “Koo So Pills” and on the package insert as “Koo Sar Pills”. The package literature was written in Chinese. Lead is not among the 11 listed ingredients. The insert states “These medical pills are good for general debility.” The directions for dosage are one pill taken with warm water two times daily (not 6 pills per day). The lead content in samples purchased at different shops in San Francisco was 2.7 ppm (0.9 micrograms per pill) and 4.3 ppm (1.4 micrograms per pill) respectively.

No other cases of lead poisoning have been reported in association with Koo Sar pills and it is thought that the varying lead concentrations in the different samples of the pills probably resulted from varying amounts of lead present during the manufacture of the red dye.

Reference: Morbidity and Mortality Weekly Review 48 (2): 27-29 (1999).