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Journalism of Courage
What triggered sudden cardiac arrest in actor-performer Shefali Jariwala is the question that’s on everybody’s mind, especially after police found evidence of self-medication. Among the things bandied about in media reports are that she took anti-ageing pills and relied on skin improvement treatments like glutathione. Generally, most reports argue that she had built a drug dependency, and on a day she was fasting, she had reacted to something that may have sent her body into allergic shock, causing sudden death. But is that the real story?
The real story that nobody wants to talk about is the pressure that social media exerts on prioritising agelessness, the extent of obsession that drives people to resort to all sorts of bio hacks being peddled online instead of going to a doctor, a greedy and unregulated supplement industry which peddles “safe” ways to stop the wrinkles and an appearance-conscious world which imposes new standards of acceptance every day. We spoke with experts to find out why anti-ageing procedures go wrong.
This comprises drugs or combinations of drugs and compounds which slow down ageing.First there are concentrated supplements like those of the flavonoid quercetin — one of the most abundant polyphenols found in fruits, vegetables, nuts, wine, and black tea — curcumin, NR (Nicotinamide Riboside, a form of vitamin B3), NMN (Nicotinamide Mononucleotide, a compound broken down from Vitamin B3), and even repurposed concoctions made from drugs meant for other diseases. “The problem with repurposed drugs is that they may have US FDA (Food and Drug Administration) and even CDSCO (Central Drugs Standard Control Organisation) approvals for a certain disease. But then their components are played around with by certain supplement makers claiming anti-ageing properties,” says Dr Rishi Parashar, Chairman, Dermatology, Sir Gangaram Hospital, Delhi.
“Besides, the so-called herbal supplements market is unregulated and we do not know what is being put into them or whether they are within safe limits. Also, many anti-ageing medications that are in clinical trials have not yielded any significant positive results. Most of these trials are animal studies and the results may be completely different in human trials. The efficacy of anti-ageing compounds, as being touted now, will take years to show results. Till then, what you read on social media is nothing short of quackery,” he adds.
What about Botox injections going bad?
Over the last 20 years, Dr Parashar has been administering Botox injections and fillers for anti-ageing. Derived from a bacterium called clostridium botulinum, its toxin paralyses and relaxes facial muscles and hence reduces wrinkles. “The jab has been proven to be safe except for complications in very rare cases, most of which got resolved too. The only thing required is that they be administered by a registered dermatologist in a medical facility that meets stringent hygiene and safety standards. Some injectable treatments include prescription medication and so should only be administered by a qualified nurse or doctor, following an initial consultation,” insists Dr Parashar.
Suspicions around Botox gained momentum in April 2024 when the US Centre for Disease Control and Prevention (CDC) released an alert warning that 22 women between 25 and 59 had “harmful reactions” to counterfeit or mishandled Botox. Eleven people were hospitalised, and six were treated with an antitoxin because of concerns around botulism – a condition where the toxin spreads beyond the local site and attacks the central nervous system causing muscle paralysis, difficulty breathing and even death. Symptoms included blurry and double vision, drooping eyelids, difficulty swallowing, slurred speech, difficulty breathing, fatigue, and weakness. “It was proven that all the women received injections from unlicensed or untrained people in places that were not healthcare centres. We have many such neighbourhood clinics mushrooming in India,” says Dr Parashar.
Botox procedures are allowed only in certain parts of the face. If you apply the same routine elsewhere on your face or any other body part where it is not meant to, there will be adverse reactions.
What’s the truth about glutathione?
Another compound that’s much misunderstood is the antioxidant glutathione, often used for skin lightening because it manages to suppress the levels of melanin that regulates skin pigmentation. Hence its popularity in skin creams, serums and lotions, all meant for topical application.
“But the real risk is in the use of IV (intravenous) glutathione, which many Bollywood celebrities are endorsing too. The US Food and Drug Administration (FDA) does not approve its use for cosmetic skin lightening. It is not available with long-term safety data, and potential side effects include allergic reactions, low blood pressure, kidney injury and interference with the body’s natural antioxidant balance. Various global health authorities even warn against its use for vanity purposes,” says cosmetic surgeon Dr Anup Dhir.
The Central Drugs Standard Control Organisation (CDSCO) has not approved glutathione for skin lightening though it’s widely used off-label for that purpose. “It is actually authorised for intravenous use in conditions like alcoholic fatty liver, fibrosis, cirrhosis, and alcoholic hepatitis and sometimes to neutralise the toxicity from chemotherapy,” says Dr Dhir.
Yet skin clinics administer glutathione injections, often alongside Vitamin C, for skin lightening. “Research on the cosmetic effects of all IV infusions is limited. While some anecdotal evidence suggests positive results, these are often based on individual experiences rather than studies. Besides, how much of it is being absorbed by the body to make a remarkable skin tone difference is a matter of debate,” says Dr Dhir, who never advises this injection.
IV products should only be given by a healthcare provider, not by a salon hand. “That’s why you see so many cases of skin eruptions and damage. A very important part of a glutathione injection is dosage, which needs to be calibrated and administered as per body weight. The recommended daily dose of glutathione for adults ranges from 500-2,000 mg per day when taken orally, or 10-20 mg/kg body weight when administered intravenously for disease supportive therapies. Who knows how much is being given for the skin?” asks Dr Dhir.
Other potential risks include transmission of infectious agents, such as HIV, hepatitis C and B when a non-medical practitioner administers this treatment in a non-sterile facility.
Do not buy online
Dr Parashar argues for strict monitoring of online sales of such products. “Users buy them on the basis of the label’s declared promises as a safe beauty product. The platform aggregator is least concerned about the concentration of their ingredients or their side effects. Users go to the local skin clinic and get them administered. They wouldn’t even know that they would have to seek prompt medical attention if something goes awry,” he warns.
