What Is Aristolochic Acid?

Annette McDermott
Reviewed by Terri Forehand RN
Aristolochia grandiflora
Aristolochia Grandiflora

Aristolochic acid comes from plants of the Aristolochiaceae family which include the Aristolochia and Asarum plants. They are used in Traditional Chinese Medicine (TCM) and grow in North America and throughout the world. Warnings and alerts abound about the natural acid.

History

Aristolochic acid played a role in TCM for thousands of years, states a Decoded Science article. The herb Aristocholia clematitis, also known as birthwort, contains aristolochic acid and has been used worldwide in childbirth. The article says that of the over 5,000 herbs used in TCM, seven contain aristolochic acid and of those seven, five contain trace amounts of the compound and two high amounts.

The two TCM herbs that contain high levels of aristolochic acid are Guang Fang Ji and Guan Mu Tong. Their use is not recommended in TCM, although some practitioners still use them. The remaining five herbs that contain the compound are rarely used by TCM practitioners.

According to a separate Decoded Science article, the aristolochic-containing herb most prescribed is Xi Xen. This herb is considered safe to use in TCM because it contains negligible amounts of aristolochic acid, is used under supervision for a short period of time, and the decoction process helps counter any toxicity.

Uses

Aristolochic acid may be found in dietary supplements or other botanical products. In TCM, aristolochic acid is used to treat a variety of conditions including:

  • Eczema
  • Gout
  • Arthritis
  • Chronic pain
  • Inflammation
  • Liver problems
  • Weight gain/obesity

Warnings and Alerts

The Food and Drug Administration (FDA) has concluded that aristolochic acid is carcinogenic and causes nephrotoxicity and they do not support its use in any form. They claim it causes severe kidney damage, kidney failure and certain types of cancer - in particular, urinary tract cancers.

  • Two UK patients experienced severe kidney damage after taking botanical products containing aristolochic acid.
  • Two U.S. patients developed kidney disease associated with botanical products containing aristolochic acid.
  • There have been approximately 100 cases of severe renal disease occurring in patients who participated in a "slimming regimen" in Belgium from 1990-1992. Part of the regimen included taking an herbal weight-reducing pill containing powdered herbs. One of the herbs (Stephania tetrandra) was accidently replaced with a botanical known to contain aristolochic acid.

The FDA took steps to warn the public about aristolochic acid risks:

  • The FDA issued an alert warning consumers to avoid aristolochic acid and products containing the compound. Despite the alert, the ingredient may still be bought on the Internet or found as a contaminant in some herbal supplements. To make sure you aren't using it, consult the FDA's List of Botanicals Determined to Contain Aristocholic Acid.
  • They issued an import alert stating that any product labeled "Aristolochia" is only allowed in the U.S. after testing proves it does not contain aristolochic acid.
  • They alerted the herbal supplement industry to review manufacturing procedures to make sure products undergo proper laboratory testing and report adverse side effects. Despite this alert, keep in mind that the FDA does not regulate the supplement industry and relies on the manufacturers to make sure products are safe and pure.
  • They issued a letter to health care professionals about the dangers of aristolochic acid and requested they review cases of unexplained renal disease.

Research

According to the National Toxicology Program, human and animal research support the toxicity of aristolochic acids.

  • Human studies showed high urologic cancer rates in people with renal or kidney disease who took aristolochic acid botanicals.
  • Various animal studies determined that oral exposure to aristolochic acids results in forestomach tumors and urinary tract tumors.
  • Mechanistic data showed that aristocholic acids are the compounds in the botanical products causing the adverse effects.

Avoid the Compound

Just because a product is natural does not mean it's safe. Some herbs have incredible healing properties while others are toxic. Based on its potential to cause severe and possibly deadly side effects, aristolochic acid should not be used.

If you have used or suspect you may have used aristocholic acid, the FDA recommends contacting your doctor right away.

What Is Aristolochic Acid?