Traditional herbal preparations (THPs) used in Ayurveda, Traditional Chinese Medicine (TCM), Traditional Tibetan Medicine (TTM) and other Asian traditional medicine systems may contain significant amounts of mercury, arsenic or lead. Though deliberately incorporated in Asian THPs for therapeutic purposes, these constituents have caused intoxications worldwide. The aim of this study was therefore to determine mercury, arsenic and lead levels in Asian THPs on the Dutch market. 292 THPs used in Ayurveda, TCM and TTM were sampled between 2004 and 2007. Samples were mostly multi ingredient THPs containing herbs and minerals. The labeling of less than 20% of the THPs suggested the presence of mercury, arsenic or lead. These elements were shown by ICP-MS in 186 (64%) of 292 THPs. Estimated weekly mercury, arsenic and lead intake levels were calculated for each THP from the analytically determined concentrations and the recommended dose. 59 THPs (20%) were likely to result in intakes of these elements significantly exceeding safety limits. Of these 59 THPs, intake estimates for 50 THPs significantly exceeded the safety limit for mercury (range 1.4 - 1747 mg/wk); intake estimates for 26 THPs significantly exceeded the safety limit for arsenic (range 0.53 - 427 mg/wk) and intake estimates for 8 THPs were significantly above the safety limit for lead (range 2.6 - 192 mg/wk). It is concluded that the mercury, arsenic and lead contents of THPs used in Ayurveda, TCM and TTM remain a cause for concern and require strict control.