HerbalEGram: Volume 8, Number 9, September 2011
Fenugreek Products Pulled From Germany's Shelves During European E. coli Outbreak No new Escherichia
coli infections have been reported in Europe since mid-July, marking the
end of the deadliest E. coli outbreak
in history.1,2 The Robert Koch Institute (RKI), Germany’s disease
control agency, identified fenugreek (Trigonella
foenum-graecum) seeds imported from Egypt as the source of the outbreak.3 More than 50 people died and approximately 4,400 people were left ill after
eating raw fenugreek sprouts harvested from the contaminated seeds.4
The outbreak began on May 21 when RKI reported a cluster of
kidney failure cases in Germany associated with a particularly virulent strain of
E. coli known as Shiga toxin-producing
E. coli (STEC), type O104:H4.3
Symptoms of a STEC infection include severe
stomach cramps, bloody diarrhea, and vomiting. In some serious cases, patients
may develop hemolytic-uremic syndrome (HUS). HUS occurs approximately 1 week after exposure to the
bacteria and can lead to kidney failure and, eventually, death.5,6
In June, a number of people with similar symptoms became ill
after attending an event in the Bordeaux region of France, according to a
report by the European Food Safety Authority (EFSA). In both cases, the infection
was linked to fenugreek sprouts harvested from a single farm in Germany. A “trace-back”
report by EFSA found that the German producer had imported 75 kg of the tainted
seeds from Egypt in 2009.7 Mathias
Schmidt, PhD, a pharmacist with HERBResearch Germany, was
puzzled by the outbreak. “What I do not understand is why the contamination was
not discovered. Officially the manufacturers do microbiological testings, and E. coli is always part of the package,”
he said (e-mail communication, September 7, 2011). “There are 2 possible
reasons: Either the seeds were tested, and the problem was not detected as a
random effect of sampling, or the material was not tested.”
As an herbal remedy, fenugreek seed is often used to treat symptoms associated
with type 2 diabetes by helping to normalize blood sugar levels. Fenugreek can
also be used to treat loss of appetite, upset stomach, and can be applied
topically to reduce inflammation.8 It also has been traditionally
used as a galactagogue to increase breast milk production.9 Joe Veilleux, the general manager of Euromed U.S.A., is
familiar with American regulations but does not deal with fenugreek or other
fresh plant material. The mandatory screening procedures for Euromed’s
products—standardized herbal extracts and natural active substances for the pharmaceutical,
food, and cosmetic industries—eliminates the risk of E. coli contamination. Veilleux explained that import regulations differ by product
category. In the United States, he noted, herbal products are usually regulated
as dietary supplements, a subset of foods. Both food and drugs are subject to
guidelines known as current Good Manufacturing Practices (cGMPs), in which
microbial testing is required. In order to be classified as a drug—which is
seldom the case in the United States—each herbal ingredient in the product must
go through a process that includes meeting stringent cGMP requirements for
purity, plus human clinical trials to determine safety and efficacy. Dietary
supplements, which have to meet high standards for identity and purity, do not
have to go through the same rigorous testing for purity and safety as do drugs.
“In Europe, because [our products] are more like medicine, many of the
companies there require [the more stringent] drug GMPs,” said Veilleux (oral
communication, July 24, 2011).
In July, the European Commission, an EU governing body, adopted emergency
measures requiring member countries to remove and destroy specific lots of
fenugreek seed imported from Egypt since 2009. Health officials from the German Federal Institute
for Drugs and Medical Devices (BfArM) went a step further in
requiring any medicinal products containing fenugreek seed to be removed from
markets.10 Further imports of the seed in all EU member countries have
been prohibited until October 31 of this year.
“I think the BfArM overreacted by revoking the marketing
authorizations of fenugreek-containing products, without even a re-test,” said Schmidt.
“The new version of E. coli should
have been detected even with the standard test battery.” According to the
European Commission report, the organically-grown seeds contaminated with
strain O104:H4 “[reflect] a production process which allowed contamination of
fecal material of human and/or animal origin.” 11 Gencor’s Veeravalli said there is general confusion about the
definition of organically produced products. “I think ‘organic’ by itself
should not mean it’s safe or better,” he said. “The average consumer has got to
be educated properly on what the product is and why we say organic is better.” Although organic products are not immune from E. coli contamination, Veeravalli said this
type of situation is rare in the herbal market. “I think every once in a while
there is some [contaminated] product coming into the market, and one has to be
a little cautious,” he said. “But it’s not the rule; it’s the exception.”
—Tyler Smith
References
1. Germany declares end to E. coli outbreak. Reuters. July 25, 2011. Available at: www.reuters.com/article/2011/07/26/us-germany-ecoli-idUSTRE76P42B20110726.
Accessed July 25, 2011.
2. European
Centre for Disease Prevention and Control. Rapid risk assessment: Outbreak of
Shiga toxin-producing E. coli (STEC)
in Germany. Available at: www.ecdc.
europa.eu/en/publications/Publications/1105_TER_Risk_assessment_EColi.pdf.
Published May 27, 2011. Accessed July 15, 2011.
3. EHEC/HUS
Outbreak. Robert Koch Institute website. Available at:
www.rki.de/EN/Home/homepage__node.html. Accessed July 25, 2011.
4. EU bans
Egyptian seeds after link to deadly E.
coli. Reuters. July 5, 2011. Available at: www.reuters.com/article/2011/07/05/uk-ecoli-europe-idUSLNE
76404S20110705. Accessed July 18, 2011.
5. Hemolytic-uremic
syndrome. MedlinePlus website. Available at: www.nlm.nih.gov/
medlineplus/ency/article/000510.htm. Accessed July 15, 2011.
6. Escherichia
coli O157:H7 and other Shiga toxin-producing Escherichia coli (STEC). Centers for Disease Control and Prevention
website. Available at:
www.cdc.gov/nczved/divisions/dfbmd/diseases/ecoli_o157h7/. Accessed July 15,
2011.
7. European
Food Safety Authority. Tracing of seeds, in particular fenugreek (Trigonella foenum-graecum), in the
context of an STEC outbreak in Germany and France. Available at:
www.efsa.europa.eu/en/supporting/pub/176e.htm. Published July 5, 2011. Accessed
July 17, 2011.
8. Fenugreek
seed. In: Blumenthal M, ed. Herbal
Medicine: Expanded Commission E Monographs. Boston, MA: Integrative
Medicine Communications; 2000. Available
at: http://cms.herbalgram.org/expandedE/Fenugreekseed.html. Accessed August 8,
2011.
9. Herbs
at a glance: Fenugreek. National Center for Complementary and Alternative
Medicine website. Available at: http://nccam.nih.gov/health/fenugreek. Accessed
July 14, 2011.
10. Relevance
of EHEC O104:H4 in fenugreek seeds which are processed into other foods than
sprouts and germ buds. Bundesinstitut für Risikobewertung (Federal Institute
for Risk Assessment). Available at: www.bfr.bund.de/cm/349/relevance_of_ehec_o104_h4
_in_fenugreek_seeds_wich_are_processed_into_other_foods_than_sprouds_and_germ_buds.pdf.
Accessed August 11, 2011.
11. European
Union. Commission implementing decision of 6 July 2011 on emergency measures
applicable to fenugreek seeds and certain seeds and beans imported from Egypt.
Available at:
http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2011:179:
0010:0012:EN:PDF. Published July 6, 2011. Accessed July 8, 2011.
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