November 22, 2024 • 16 mins
Dr. Oliver Grundmann talks about kratom's adverse effects, including addiction risks, constipation, nausea, and potential liver toxicity. He emphasizes that liver concerns are rare, dose-dependent, and often complicated by other factors like alcohol use, while stressing the need for better product regulation.
...
This is a clip from 'All About Kratom | Dr. Oliver Grundmann'- ATTMind Podcast Episode 121
- Watch in Video here: https://www.youtube.com/watch?v=0BdhEwSZ5lw
- Full Episode and show notes here: https://bit.ly/ATTMind121
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Let's talk about adverse effects because we had talked earlier
I mean one obvious adverse effect is you could get addicted to it like you could become physiologically dependent on
this substance and I
actually had someone I had made a post about having kratom as a part of my life and
I had gotten somebody else that had said to me that they were felt like they were in a bit of trouble because
(00:22):
They were using kratom
And they were using it based on this. Oh
It's okay because it's natural blah blah blah this misunderstanding and then all of a sudden they need 10 grams a day
Or they feel like they're falling apart
Right and it just sort of crept up on them and they didn't think about it because it was no big deal
similarly in some sense
(00:43):
Maybe as people who don't really
Seem to think coffee is a big deal and then they're eating drinking six seven eight cups a day
And if they don't get at least five then they feel like shit and they treat other people like shit
But you know coming off of coffee, although painful maybe is less intense than coming off of something that has an opioid
Effect in the body but we have this potential danger of addiction or excuse me physiological dependence
(01:10):
What are the other adverse effects that are present for?
Kratom that we know of either acutely
Since you said it doesn't tend to suppress the respiratory system or chronically
so what has been reported in the literature and what we have seen is
classical
(01:32):
So for one it's it's it's a dose-dependent
Adverse effect profile that we see
we see constipation as
as one of the
primary and most reported adverse effects
Which you can expect from an opioid or from something that acts on opioid receptors
We see nausea and vomiting
(01:54):
That can occur primarily nausea and not so much vomiting the issue with
Ingesting or drinking the actual
Extract if you just have the powder and you drink it some people use honey or something if a
Orange juice anything that makes it a little bit more palatable
(02:16):
Because it is rather bitter if you drink it and it's not it's not very well tasting
So that can cause just nausea
Potentially and there is just a limit of how much you can
drink at a time without having really a very bad stomach experience stomach upset was also a
(02:37):
common adverse effect
I guess when you take it in pill form you avoid those effects those adverse effects to some degree
Then what is a little bit more serious are
Potential effects on the liver that have been reported
after a few days of
(02:58):
ingestion
so that can occur within
five to ten days
Depending a little bit. That's what I've seen in the literature
let's let me let's zoom in on that before you continue because this is sort of like kind of hot
I mean it kind of comes and goes was sort of hot right now because there was recently a report that came out from
(03:19):
You know like a big organization that talks about
liver toxicity of different substances and stuff and liver health and they were suggesting that
That oh, there's I think one of the one of them
Headlines I saw which headlines don't mean shit, but it was you know like this association is sounding the alarm on kratom
And then when I sent you that report, I mean you said something like this is a very interesting use of data
(03:44):
So are we talking like people who take kratom every day for five to ten days in a row at?
You know we'll say maybe five or something grams
Usually common is about five to eight grams at a higher dose for people that that causes liver problems
Or is it more complex than that is it everybody is it some people is the reports like do we know?
(04:08):
Definitively it was kratom is there some sort of genetic predisposition?
What do we know like what is what is like the the reasonable assessment of danger around liver toxicity with kratom?
so
when we talk about
causation
something being causative something
(04:29):
Being the reason that something else happens so kratom being the reason that we have a liver toxicity
We stand on currently we don't stand on very solid ground
Yes, we can say that kratom in some cases may contribute to
(04:51):
liver a
toxicity to liver adverse effects in the report that you sent me and that's what I am
Analyzing now they are more reports in the literature, but let me just focus on that one as an example for now
There were seven reports of liver toxicity that were specifically discussed in that one six of them
(05:15):
also used alcohol
So alcohol is a known liver
toxicant
So if you combine that with kratom there were also no other
Reports of what other medications were these patients potentially on so if we throw in
(05:36):
something else like benzodiazepine or
Something like acetaminophen something like tylenol that is also liver toxic
What our additive effects like so we have a lot of different
Factors that can play into that now
I don't I don't want to downplay that some people may be at higher risk of developing liver toxicity with the use with the high
(06:04):
Use of kratom with high doses of kratom and they should be
careful with using kratom
They might want to consider
Consulting with a health care professional
Or at least checking if not to use other
potential liver toxicants such as alcohol
(06:26):
Or acetaminophen if you use it for pain for example, and you also using ibuprofen or acetaminophen
In conjunction with kratom then you might be at an increased risk of developing liver toxicity
So you have a lot of factors that can play into that
in addition
and that's another point that I
(06:49):
sometimes like to harp on together, but I feel like we have been harping on that as
not only as researchers, but also as just I
want to say caring individuals, but I
maybe I'm
That the issue currently is that since the FDA is saying kratom is no good. We want a gun basically entirely
(07:15):
that we don't have any
Regulation really regarding what kratom products are entering the United States
so we don't have really any quality control of what consumers have access to and
therefore there might be kratom products out there that
contain
(07:36):
pesticides that contain
anything heavy metals that
Might actually not be healthy that might be
Really not good. So if we had better regulations in place where we have some kind of
just
Where consumers knew that they had a good quality kratom product that they have access to with some kind of
(08:03):
labeling guideline and
some kind of at least internal lab check
That we know that good manufacturing practices are followed then we might have had a
Better chance to at least reduce a number of kratom
(08:24):
Associated liver
Incidences now if you compare these seven cases to the annual cases of
Tylenol related liver toxicity
I don't know if I can display that in in a graph, but it's like minuscule
It's it's really nothing now
(08:44):
I don't want to downplay these six or seven cases though because everybody who obviously has adverse effects
so we need to be careful need to be aware of that and and
Everybody who intends to use kratom should always look at their current medication that they're taking and and should be aware of
potential drug interactions
(09:05):
So so what you're saying here is there is absolutely
evidence and reason to be cautious around liver toxicity with kratom
Although it is not as it is not a oh my god kratom causes liver damage
Scenario the way that it's being presented in the report that I sent you where it's you know sounding the alarm on kratom
(09:28):
so not I if everybody who was using kratom would have
Elevated liver enzyme values as what was reported in this case
Then I would definitely say stay away from kratom
I would not be
kratom what I don't think that we would have five to sixteen million somewhere in that range of kratom users in the United States
(09:56):
So if you are taking kratom in reasonable doses
Three to five grams five to eight is already on the high end to be honest three to five grams per dose
three doses per day
And you you have a good
Kratom product that
(10:19):
Meets kind of the current labeling guidelines that have been put forward by the American kratom Association
Then I would say that you are probably doing the best you can
And you keep in mind potential drug interactions with other drugs that can affect your liver
Then you're probably doing the best you can at the moment to avoid liver toxicity
(10:42):
I'm not excluding it entirely, but you're probably doing the best that you can hmm
yeah, I'm just thinking about the
Like the percentage difference between five to seven cases out of fifteen to or five to sixteen million people taking kratom
And how significant that is although when I started doing further research there definitely was multiple reports online of people having
(11:05):
liver issues although one person
They had expressed they had some sort of credentials to make this statement had
Said it had something to do with a genetic predisposition towards how well you detox in your liver or
with kratom specifically and and that all the reports that had been discussed on the unlike thredits and stuff
(11:28):
Said that okay, this is what happens after yeah five to ten days your own gets very yellow
You start to develop jaundice and there's these other effects and that that every case that had been talked about
Was like as soon as kratom was discontinued all those all those effects went away
And they went back to normal that it wasn't permanent effect as long as those things were noticed and like kratom use was stopped immediately
(11:53):
Do you have any more information on that or is that sort of like what we know?
That is our current knowledge. Yes now
If if it's only the liver toxicity if that is the only occurring symptom like you said yondis
Then discontinuations obviously the path to go
And if I would still advise to consult with a healthcare provider because there might be other issues associated with that
(12:22):
It might not be the kratom. It might be something else that's going on. So
It's always good to to seek out a healthcare provider and such situations
great
We were talking about adverse effects
and I am curious if you have more to add before I ask you specifically about what does and does not
(12:45):
Sort of count as I think with the recent study from John Johns Hopkins said was a kratom use disorder
Is there any other adverse effects you want to mention before we go on to that topic?
So there have been a few reports of
particularly
lung
edema
(13:06):
acute lung edema that have been attributed to
potentially
High metrog
(13:31):
It might be something related to the cardiovascular system, so it might have something to do with heart
People might be predisposed if they use kratom in very high amounts well above 8 grams
per dose
If they use it over a long period of time that they may develop
(13:52):
Cardiovascular issues so something with the heart something with blood pressure
that then might extend to particularly the lungs and
that
But it has only been shown in isolated cases so far
So that that is something that I have
(14:12):
Seen it has been reported in I believe four cases to date
postmortem, so
Where mitra gynin was detected in the blood of deceased people
interesting
Any was that the last was that the last one?
That was
(14:34):
There are certainly others, but those were the ones that were standing out to me
That people I think should be aware of yeah
Thank you for tuning in to this micro
Micros is a mini series here on the podcast where we share curated sections of various episodes out of the archive
(14:57):
This clip came from episode 121 titled all about kratom with dr
Oliver grunman if you're interested in listening to the whole interview it is available on whatever podcatcher you are listening on now
And I will link to the show notes to that interview in the description here
If you like what you heard please do subscribe to the show to stay informed on new episodes
(15:17):
Dropping monthly, and if you found slash our finding value in the show you can reciprocate that value through a one-time
PayPal or Bitcoin donation or by becoming my patron on patreon links again are in the description
Finally if you would like to stay connected on social media you can find me at James W
Gesso on most networks last name is J E S S O and at at mine podcast on
(15:45):
Instagram specifically at mine is a
TTM
IND podcast so adventures to the mind a TTM IND podcast on Instagram
But if social media is not your jam if you're not interested in relying on the algorithm
You can sign up for my email newsletter join the podcast telegram channel or become a free member on patreon and as you've probably guessed
(16:10):
All links are in the description and that's it
Thanks again for tuning in to adventures through the mind and until the next episode
I've been your host, James W. Gesso. Take care, stay curious.
Let's talk about adverse effects because we had talked earlier
I mean one obvious adverse effect is you could get addicted to it like you could become physiologically dependent on
this substance and I
actually had someone I had made a post about having kratom as a part of my life and
I had gotten somebody else that had said to me that they were felt like they were in a bit of trouble because
(00:22):
They were using kratom
And they were using it based on this. Oh
It's okay because it's natural blah blah blah this misunderstanding and then all of a sudden they need 10 grams a day
Or they feel like they're falling apart
Right and it just sort of crept up on them and they didn't think about it because it was no big deal
similarly in some sense
(00:43):
Maybe as people who don't really
Seem to think coffee is a big deal and then they're eating drinking six seven eight cups a day
And if they don't get at least five then they feel like shit and they treat other people like shit
But you know coming off of coffee, although painful maybe is less intense than coming off of something that has an opioid
Effect in the body but we have this potential danger of addiction or excuse me physiological dependence
(01:10):
What are the other adverse effects that are present for?
Kratom that we know of either acutely
Since you said it doesn't tend to suppress the respiratory system or chronically
so what has been reported in the literature and what we have seen is
classical
(01:32):
So for one it's it's it's a dose-dependent
Adverse effect profile that we see
we see constipation as
as one of the
primary and most reported adverse effects
Which you can expect from an opioid or from something that acts on opioid receptors
We see nausea and vomiting
(01:54):
That can occur primarily nausea and not so much vomiting the issue with
Ingesting or drinking the actual
Extract if you just have the powder and you drink it some people use honey or something if a
Orange juice anything that makes it a little bit more palatable
(02:16):
Because it is rather bitter if you drink it and it's not it's not very well tasting
So that can cause just nausea
Potentially and there is just a limit of how much you can
drink at a time without having really a very bad stomach experience stomach upset was also a
(02:37):
common adverse effect
I guess when you take it in pill form you avoid those effects those adverse effects to some degree
Then what is a little bit more serious are
Potential effects on the liver that have been reported
after a few days of
(02:58):
ingestion
so that can occur within
five to ten days
Depending a little bit. That's what I've seen in the literature
let's let me let's zoom in on that before you continue because this is sort of like kind of hot
I mean it kind of comes and goes was sort of hot right now because there was recently a report that came out from
(03:19):
You know like a big organization that talks about
liver toxicity of different substances and stuff and liver health and they were suggesting that
That oh, there's I think one of the one of them
Headlines I saw which headlines don't mean shit, but it was you know like this association is sounding the alarm on kratom
And then when I sent you that report, I mean you said something like this is a very interesting use of data
(03:44):
So are we talking like people who take kratom every day for five to ten days in a row at?
You know we'll say maybe five or something grams
Usually common is about five to eight grams at a higher dose for people that that causes liver problems
Or is it more complex than that is it everybody is it some people is the reports like do we know?
(04:08):
Definitively it was kratom is there some sort of genetic predisposition?
What do we know like what is what is like the the reasonable assessment of danger around liver toxicity with kratom?
so
when we talk about
causation
something being causative something
(04:29):
Being the reason that something else happens so kratom being the reason that we have a liver toxicity
We stand on currently we don't stand on very solid ground
Yes, we can say that kratom in some cases may contribute to
(04:51):
liver a
toxicity to liver adverse effects in the report that you sent me and that's what I am
Analyzing now they are more reports in the literature, but let me just focus on that one as an example for now
There were seven reports of liver toxicity that were specifically discussed in that one six of them
(05:15):
also used alcohol
So alcohol is a known liver
toxicant
So if you combine that with kratom there were also no other
Reports of what other medications were these patients potentially on so if we throw in
(05:36):
something else like benzodiazepine or
Something like acetaminophen something like tylenol that is also liver toxic
What our additive effects like so we have a lot of different
Factors that can play into that now
I don't I don't want to downplay that some people may be at higher risk of developing liver toxicity with the use with the high
(06:04):
Use of kratom with high doses of kratom and they should be
careful with using kratom
They might want to consider
Consulting with a health care professional
Or at least checking if not to use other
potential liver toxicants such as alcohol
(06:26):
Or acetaminophen if you use it for pain for example, and you also using ibuprofen or acetaminophen
In conjunction with kratom then you might be at an increased risk of developing liver toxicity
So you have a lot of factors that can play into that
in addition
and that's another point that I
(06:49):
sometimes like to harp on together, but I feel like we have been harping on that as
not only as researchers, but also as just I
want to say caring individuals, but I
maybe I'm
That the issue currently is that since the FDA is saying kratom is no good. We want a gun basically entirely
(07:15):
that we don't have any
Regulation really regarding what kratom products are entering the United States
so we don't have really any quality control of what consumers have access to and
therefore there might be kratom products out there that
contain
(07:36):
pesticides that contain
anything heavy metals that
Might actually not be healthy that might be
Really not good. So if we had better regulations in place where we have some kind of
just
Where consumers knew that they had a good quality kratom product that they have access to with some kind of
(08:03):
labeling guideline and
some kind of at least internal lab check
That we know that good manufacturing practices are followed then we might have had a
Better chance to at least reduce a number of kratom
(08:24):
Associated liver
Incidences now if you compare these seven cases to the annual cases of
Tylenol related liver toxicity
I don't know if I can display that in in a graph, but it's like minuscule
It's it's really nothing now
(08:44):
I don't want to downplay these six or seven cases though because everybody who obviously has adverse effects
so we need to be careful need to be aware of that and and
Everybody who intends to use kratom should always look at their current medication that they're taking and and should be aware of
potential drug interactions
(09:05):
So so what you're saying here is there is absolutely
evidence and reason to be cautious around liver toxicity with kratom
Although it is not as it is not a oh my god kratom causes liver damage
Scenario the way that it's being presented in the report that I sent you where it's you know sounding the alarm on kratom
(09:28):
so not I if everybody who was using kratom would have
Elevated liver enzyme values as what was reported in this case
Then I would definitely say stay away from kratom
I would not be
kratom what I don't think that we would have five to sixteen million somewhere in that range of kratom users in the United States
(09:56):
So if you are taking kratom in reasonable doses
Three to five grams five to eight is already on the high end to be honest three to five grams per dose
three doses per day
And you you have a good
Kratom product that
(10:19):
Meets kind of the current labeling guidelines that have been put forward by the American kratom Association
Then I would say that you are probably doing the best you can
And you keep in mind potential drug interactions with other drugs that can affect your liver
Then you're probably doing the best you can at the moment to avoid liver toxicity
(10:42):
I'm not excluding it entirely, but you're probably doing the best that you can hmm
yeah, I'm just thinking about the
Like the percentage difference between five to seven cases out of fifteen to or five to sixteen million people taking kratom
And how significant that is although when I started doing further research there definitely was multiple reports online of people having
(11:05):
liver issues although one person
They had expressed they had some sort of credentials to make this statement had
Said it had something to do with a genetic predisposition towards how well you detox in your liver or
with kratom specifically and and that all the reports that had been discussed on the unlike thredits and stuff
(11:28):
Said that okay, this is what happens after yeah five to ten days your own gets very yellow
You start to develop jaundice and there's these other effects and that that every case that had been talked about
Was like as soon as kratom was discontinued all those all those effects went away
And they went back to normal that it wasn't permanent effect as long as those things were noticed and like kratom use was stopped immediately
(11:53):
Do you have any more information on that or is that sort of like what we know?
That is our current knowledge. Yes now
If if it's only the liver toxicity if that is the only occurring symptom like you said yondis
Then discontinuations obviously the path to go
And if I would still advise to consult with a healthcare provider because there might be other issues associated with that
(12:22):
It might not be the kratom. It might be something else that's going on. So
It's always good to to seek out a healthcare provider and such situations
great
We were talking about adverse effects
and I am curious if you have more to add before I ask you specifically about what does and does not
(12:45):
Sort of count as I think with the recent study from John Johns Hopkins said was a kratom use disorder
Is there any other adverse effects you want to mention before we go on to that topic?
So there have been a few reports of
particularly
lung
edema
(13:06):
acute lung edema that have been attributed to
potentially
High metrog
(13:31):
It might be something related to the cardiovascular system, so it might have something to do with heart
People might be predisposed if they use kratom in very high amounts well above 8 grams
per dose
If they use it over a long period of time that they may develop
(13:52):
Cardiovascular issues so something with the heart something with blood pressure
that then might extend to particularly the lungs and
that
But it has only been shown in isolated cases so far
So that that is something that I have
(14:12):
Seen it has been reported in I believe four cases to date
postmortem, so
Where mitra gynin was detected in the blood of deceased people
interesting
Any was that the last was that the last one?
That was
(14:34):
There are certainly others, but those were the ones that were standing out to me
That people I think should be aware of yeah
Thank you for tuning in to this micro
Micros is a mini series here on the podcast where we share curated sections of various episodes out of the archive
(14:57):
This clip came from episode 121 titled all about kratom with dr
Oliver grunman if you're interested in listening to the whole interview it is available on whatever podcatcher you are listening on now
And I will link to the show notes to that interview in the description here
If you like what you heard please do subscribe to the show to stay informed on new episodes
(15:17):
Dropping monthly, and if you found slash our finding value in the show you can reciprocate that value through a one-time
PayPal or Bitcoin donation or by becoming my patron on patreon links again are in the description
Finally if you would like to stay connected on social media you can find me at James W
Gesso on most networks last name is J E S S O and at at mine podcast on
(15:45):
Instagram specifically at mine is a
TTM
IND podcast so adventures to the mind a TTM IND podcast on Instagram
But if social media is not your jam if you're not interested in relying on the algorithm
You can sign up for my email newsletter join the podcast telegram channel or become a free member on patreon and as you've probably guessed
(16:10):
All links are in the description and that's it
Thanks again for tuning in to adventures through the mind and until the next episode
I've been your host, James W. Gesso. Take care, stay curious.
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