MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

It has been reported that the wife of a Northern California congressman died late last year after ingesting a plant that is generally considered safe and is used as an herbal remedy for a variety of ailments, including diabetes, obesity, and high cholesterol. Lori McClintock, the wife of U.S. Rep. Tom McClintock, died from dehydration due to gastroenteritis caused by “adverse effects of white mulberry leaf ingestion.”  The coroner’s office ruled her death an accident. The original death certificate, dated Dec. 20, 2021, listed the cause of death as “pending.”

Tom McClintock found his 61-year-old wife unresponsive at their Elk Grove, California, home on Dec. 15, 2021, according to the coroner’s report. He had just returned from Washington, D.C., after voting in Congress the night before. It’s unclear from the autopsy report whether Lori McClintock took a dietary supplement containing white mulberry leaf, ate fresh or dried leaves, or drank them in a tea, but a “partially intact” white mulberry leaf was found in her stomach, according to the report.

McClintock’s death underscores the risks of the vast, booming market of dietary supplements and herbal remedies, which have grown into a $54 billion industry in the United States — one that both lawmakers and health care experts say needs more government scrutiny. “Many people assume if that product is sold in the United States of America, somebody has inspected it, and it must be safe. Unfortunately, that’s not always true,” U.S. Sen. Richard Durbin (D-Ill.) said on the Senate floor this spring when he introduced legislation to strengthen oversight of dietary supplements.

Daniel Fabricant, CEO and president of the Natural Products Association, which represents the dietary supplements industry, questioned whether McClintock’s death was related to a supplement. “It’s completely speculative. There’s a science to this. It’s not just what a coroner feels,” said Fabricant, who oversaw dietary supplements at the FDA during the Obama administration. “People unfortunately pass from dehydration every day, and there’s a lot of different reasons and a lot of different causes.” Fabricant said it would have been ideal had the coroner or the family reported her death to the FDA so the agency could have launched an investigation. Such reports are voluntary, and it’s not clear whether anyone reported her death to the agency. FDA spokesperson Courtney Rhodes said the agency does not discuss possible or ongoing investigations. The FDA, Fabricant added, has a system in place to investigate deaths that might be linked to a supplement or drug. “It’s casework,” he said. “It’s good, old-fashioned police work that needs to be done.”

Sacramento County spokesperson Kim Nava said via email Wednesday that the law prohibits the coroner’s office from discussing many details of specific cases. As part of any death investigation, the office “attempts to locate and review medical records and speak to family/witnesses to establish events leading up to and surrounding a death,” she said. If any medications or supplements are found at the scene or if pertinent information is in the person’s medical records, those are passed along to the pathologist to help establish cause of death, Nava said. “Any information the office obtains from medical records can’t be disseminated to a third party except by court order,” she said.

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White mulberry (Morus alba) leaves are said to possess various biological activities, including antioxidant, antimicrobial, skin-whitening, cytotoxic, anti-diabetic, glucosidase inhibition, anti-hyperlipidemic, anti-atherosclerotic, anti-obesity, cardioprotective, and cognitive enhancement activities. Rich in anthocyanins and alkaloids, mulberry fruits have pharmacological properties, such as antioxidant, anti-diabetic, anti-atherosclerotic, anti-obesity, and hepatoprotective activities. The root bark of mulberry, containing flavonoids, alkaloids, and stilbenoids, has antimicrobial, skin-whitening, cytotoxic, anti-inflammatory, and anti-hyperlipidemic properties. Other pharmacological properties of M. alba include anti-platelet, anxiolytic, anti-asthmatic, anthelmintic, antidepressant, cardioprotective, and immunomodulatory activities.

Clinical trials on the efficiency of Morus alba extracts in reducing blood glucose and cholesterol levels and enhancing cognitive ability have been conducted. Yet the findings are so far not compelling. There is an extensive history of consumption of Morus alba leaves by humans and animals worldwide. The plant is a frequent ingredient in TCM preparations. This might suggest that the leaves and their extracts have a good safety profile. However systematic investigations into the issue seem to be absent. Reports of serious adverse effects in humans are rare. Thus one might ask whether the supplement in question – if it was a supplement at all that the woman took – might have been contaminated with a toxic substance.

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