Assessment of effects on health due to consumption of bitter bottle gourd (Lagenaria siceraria) juice
SK Sharma1, Rajesh Puri2, Ajay Jain3, MP Sharma4, Anita Sharma5, Shravan Bohra6, YK Gupta1, Anoop Saraya1, S Dwivedi7, KC Gupta8, Mahadeo Prasad9, Janardhan Pandey10, Netar Prakash Dohroo11, Neeraj Tandon12, B Sesikeran13, AK Dorle14, Nikhil Tandon1, SS Handa15, GS Toteja12, Spriha Rao12, K Satyanarayana12, VM Katoch12
1 All India Institute of Medical Sciences, New Delhi, India
2 Medanta Medicity Hospital, Gurgaon, India
3 Choithram Hospital & Research Centre, Indore, India
4 Rockland Hospital, New Delhi, India
5 Himalayan Institute of Medical Sciences, Dehradun, India
6 Apollo Hospitals International, Gandhinagar, India
7 Hamdard Institute of Medical Sciences & Research, Jamia Hamdard (Hamdard University), New Delhi, India
8 Indian Institute of Toxicology Research, Lucknow, India
9 Central Council for Research in Ayurveda & Siddha, New Delhi, India
10 Department of Ayush, New Delhi, India
11 Dr Y.S. Parmar University of Horticulture & Forestry, Solan, India
12 Indian Council of Medical Research, New Delhi, India
13 National Institute of Nutrition, Hyderabad, India
14 Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur, India
15 Indian Institute of Integrated Medicine, Jammu, India
G S Toteja
Scientist 'F' and Head (Nutrition), Indian Council of Medical Research, Ansari Nagar, New Delhi & Centre for Promotion of Nutrition Research and Training with special focus on North-East, Tribal & Inaccessible Population (ICMR), ICMR Campus II, 3 Red Cross Road, Tuberculosis Association of India Building, Ist floor, Near Parliament, New Delhi 110 001
Source of Support: None, Conflict of Interest: None
Background & objectives: The bottle gourd (Lagenaria siceraria) is popularly known as lauki, ghia or dudhi in India. Its consumption is advocated by traditional healers for controlling diabetes mellitus, hypertension, liver diseases, weight loss and other associated benefits. However, in last few years there have been reports of suspected toxicity due to consumption of its juice. This led to the constitution of an Expert Committee by Department of Health Research at Indian Council of Medical Research (ICMR), Ministry of Health & Family Welfare, Government of India in October 2010. The committee looked into the issues related to safety of consumption of bottle gourd juice, and this paper presents the findings.
Methods: Information on cases of suspected toxicity due to consumption of bottle gourd juice was collected by internet search, advertising on website of ICMR and by writing to State and district health authorities as well as to medical colleges, hospitals and private nursing homes across the country.
Results: Three deaths were reported, one from Delhi and two from Uttar Pradesh after consumption of extremely bitter bottle gourd juice. Three persons who died after consumption of freshly prepared bottle gourd juice or juice mixed with bitter gourd (karela) juice were over 59 years of age and had diabetes since last 20 years. This juice was reported to be extremely bitter by all three. Twenty six persons were admitted to various hospitals of the country on complaint of abdominal pain and vomiting following consumption of freshly prepared bottle gourd juice. Diarrhoea and vomiting of blood (haematemesis) was reported in 18 (69.2%) and 19 (73.1%) patients, respectively. Biochemical investigations revealed elevated levels of liver enzymes. More than 50 per cent patients had hypotension. Endoscopic findings showed profusely bleeding stomach with excessive ulceration seen in distal oesophagus, stomach and duodenum in most of the cases. All these patients recovered fully and no sequeale was recorded for any of the cases.
Interpretation & conclusions: Cucurbitaceae family, of which bottle gourd is a member contains the toxic tetracyclic triterpenoid compounds called cucurbitacins which are responsible for the bitter taste. There is no known antidote for this toxicity and clinicians treat such cases symptomatically only. The Committee made the following recommendations: (i) The community needs to be educated that bitter tasting bottle gourd juice should not be consumed and in case there is any discomfort, nausea, vomiting, diarrhoea or any feeling of uneasiness after consumption of juice, the person should immediately be taken to a nearby hospital. (ii) Clinicians are suggested that patients coming with symptoms (discomfort, nausea, vomiting, diarrhoea, gastrointestinal bleeding after consumption of juice) should immediately be attended to and general supportive care should be provided, i.e. IV fluids/crystalloids/blood products/fresh frozen plasma to maintain the haemodynamics and electrolyte balance; Ryle's tube to be put in for gastric lavage and to assess gastrointestinal (GI) bleed- aspirate to be preserved; Proton pump inhibitors should be given for management of GI bleed and appropriate treatment for other complications should be given. (iii) The possible research areas identified are chemical composition studies on bitter and normal bottle gourd and other members of cucurbitaceae family; animal toxicity studies and studies on interaction between bottle gourd juice and other drugs.