[@hubermanlab] Health Effects & Risks of Kratom, Opioids & Other Natural Occurring Medicines | Dr. Chris McCurdy

Link: https://youtu.be/gyE6Z4GLEeM

Short Summary

Here's the requested information based on the provided transcript:

Number One Most Important Action Item/Takeaway:

Anyone considering Kratom products needs to carefully check the serving size and whether the product contains Kratom-derived compounds or isolates, as these can have significantly different and potentially more dangerous effects than traditional Kratom leaf products.

Executive Summary:

This podcast episode with Dr. Chris McCertie explores the complex and often misunderstood effects of Kratom, a plant-derived compound used for various purposes like energy, mood elevation, and pain relief. It highlights the dangers of concentrated or synthesized Kratom products, which can have strong opioid-like effects and potential for addiction, especially compared to the traditional use of Kratom leaves, as well as the importance of being aware of the potential side effects, ranging from a mild headache or low energy, to significant physical dependence and respiratory suppression.

Key Quotes

Here are 5 direct quotes from the transcript that represent valuable insights, interesting data points, surprising statements, or strong opinions:

1. "And so two things that I'm taking from what you've said thus far is that anyone considering cratom products of any kind needs to carefully consider serving size. And it's uh interesting that those small bottles and frankly the packaging of most uh things is pretty small...you need to look at the serving size and and know how many servings are in there absolutely so check serving size and the other thing is uh to look for cratom derived or cratom extracted versus actual cratom plant product..."

2. "The estimated number of users right now...the most recent literature report was around 2 million 2 and a.5 million users but if you look at sales of products and you talk to the manufacturers the estimates are well over 20 million users in the United States and if you look at the availability of product it's got to be closer to those numbers so on a daily basis on a daily basis daily basis."

3. "We know from studies with cannabis that, you know, that can slow brain development and people can have lower IQs if they start at a younger age versus people that never smoked and developed their brain fully. So we have no idea what the impact is of cratom developing brain. A lot of people will hate me for saying this, but my feeling is, you know, the drinking age should be 24, 25, just like when your insurance rates go down for your car, it's 25. It's because you have a prefrontal cortex, right? And I think when you hijack that system with any substance that can be psychoactive, you run into problems."

4. "We know that this seven hydroxy metroin... are actually causing respiratory depression equivalent to opioids." (referring to semisythetic and isolate products)

5. "Plants produce chemical defense all the time. Right? The alkyoids are by the way bitter compounds by nature. So most of the time they're anti-feedant to make sure that the passing by uh deer, giraffe, whatever is not going to eat all the leaves off of that tree. ...However interestingly enough metro speciosa thermome tree does not grow uh in a place where it's going to be attacked by herbivorous animals. These grow in very swampy um conditions...These compounds that the tree is producing...are highly effective antifungal agents for the plant to ensure its ability to survive and stay in that environment and thrive in that environment."

Detailed Summary

Here's a detailed summary of the YouTube video transcript, presented in bullet points, excluding sponsorship mentions:

• Introduction:

  • Dr. Andrew Huberman interviews Dr. Chris McCertie, a medicinal chemistry professor at the University of Florida specializing in natural products and their pharmacological effects, focusing on Kratom.
  • The episode aims to provide a thorough understanding of Kratom, its effects, and its risks, especially considering its widespread availability.

• What is Kratom?

  • Kratom (Mitragyna speciosa) is a tree native to Southeast Asia, specifically the border region of Malaysia and Thailand.
  • Traditionally, laborers in these regions chewed Kratom leaves or brewed tea (decoction) from them for energy, stamina, pain relief, mood elevation, and even as a social lubricant (especially in a Muslim society where alcohol is limited).
  • Lower doses are reported to have a stimulant effect, while higher doses can produce euphoria or a sedative, opioid-like effect.

• Kratom in the United States:

  • Kratom products in the U.S. are significantly different from the traditional use.
  • Here, Kratom is typically sold as dried leaf material, ground into powder (for capsules, teas, etc.), or in concentrated extract forms (tonics, shots).
  • Concentrated extracts have a much faster absorption rate compared to the leaf material, leading to potentially stronger effects.

• Concerns about Kratom Products:

  • The lack of product delineation in the Kratom space is problematic; all Kratom products are lumped together regardless of their concentration or form. This can lead to misuse, especially with concentrated products.
  • Serving sizes are often unclear, leading consumers to ingest much higher doses than intended, particularly with concentrated "shot" products.

• Serving Sizes and Product Types:

  • It is crucial to carefully consider the serving size and the total amount of Kratom in a product.
  • Consumers should be aware of whether they are using actual Kratom plant product or derivatives/extracts, as the latter may have different effects.

• Effects of Kratom at Different Dosages:

  • Lower dosages (with leaf material) tend to act as a stimulant, potentially with aphrodisiac qualities (suggesting dopamine and vasodilation activity).
  • Higher dosages tend to have more of a sedative effect.

• Kratom Usage Patterns in the US:

  • Most Kratom users (based on volunteer studies) use it responsibly, not seeking a "high" or euphoric effect.
  • Common uses include energy boost, mood elevation, and pain treatment (as an alternative to opioids).
  • Kratom is also used as a pre-workout stimulant or post-workout pain reliever.
  • Some people are using Kratom to get off of opiates
  • There is a smaller group of users who specifically use it to get high and seek a euphoric, relaxed state.

• Physical Dependence:

  • Kratom can cause physical dependence with regular use. The withdrawal symptoms are reported to be similar to caffeine withdrawal (headache, lethargy) for leaf material.
  • Some people report more severe physical dependence symptoms (restless leg syndrome) which more closely resembles opiate withdrawal.

• Categories of Kratom Usage in the US:

  • Caffeine-like usage for energy.
  • Use of high doses or concentrates for an opioid-like/sedative/euphoric effect.
  • Use to transition off or stay away from opioids (reported as a positive benefit for some).

• Alkaloids in Kratom:

  • Kratom contains multiple alkaloids (organic molecules with nitrogen), not just one active compound. There are at least 20-40 alkaloids.
  • Examples of alkaloids include Dopamine, Serotonin, Caffeine, Morphine, and Cocaine.

• Importance of Nitrogen in Molecules:

  • The nitrogen atom in alkaloids can act as a base and develop a charge (like a magnet attracting other charges), allowing the molecule to interact with proteins in the body. This is key for the compound's activity.

• Role of Animals:

  • Animals were the first pharmacists and first physicians who learned to recognize which plants to utilize when they were ill, and which ones to avoid to stay alive.

• Current Usage Patterns:

  • There is a loss in our culture of where medicines have come from. 75% of FDA-approved medications are either discovered because of a natural product or modified natural products.

• FDA Commissioner Thoughts:

  • Plant basedratom products are a maybe scenario.
  • Kids under the age of 18 are a hard no.
  • Adults should use it with caution and find minimal effective dose.
  • 7-hydroxy is just all bad and should be illegal.

• Slow Medicine Movement:

  • The speaker promotes a "slow medicine" movement parallel to the "slow food" concept, encouraging greater awareness of the origins and effects of medicinal substances.

• Three Paths of Kratom Usage in the US:

  • The first group uses Kratom to achieve an energetic lift, similar to a caffeine or energy drink.
  • The second path involves people who use high doses or concentrates to achieve an opioid-like, sedative effect.
  • The third category consists of people who use Kratom to get off opiates or stay away from them, for whom it is a real benefit.

• Potential Side-Effects in Young People:

  • Brain isn't fully developed till 24-25 and these products will slow brain development.

• Not Allratom is the Same:

  • It is important for the medical community and users to differentiate what they are taking, so they can better help patients with the potential negative effects.

• Kratom-Derived Products:

  • Concerns about Kratom-derived products where compounds naturally found in the leaf are chemically manipulated into potent opiods. These products are easily purchasable.

• FDA's Dietary Ingredient Rules:

  • A metabolite of a dietary ingredient can also be considered a dietary ingredient.

• 7-Hydroxymitragynine: Respiratory Depression:

  • Products containing 7-hydroxymitragynine is causing respiratory depression equivalent to opioids. The effect is reversed with Narcan.

• Isratom Good or Bad:

  • Products are not made up of just one thing, but a combination of compounds. Some advocate for science-based information on Kratom and putting guidelines in place. The FDA isn't doing this right now.
  • Some organizations see these products as a potential good alternative to Opioid abuse.

• If Taking Alcohol and Kratom:

  • Increased risk for dying from respiratory failure in the same way that Opioids do.
  • It has been reported that Kratom actually reduces alcohol consumption.

• Aphrodisiac:

  • Not specifically clear what are the pathways that make it an aphrodisiac.

• Individual Alkaloids:

  • Mytragynine: Weak affinity for opioid receptors and doesn't do much to alleviate pain. It interacts with a couple other important neurotransmitter systems.
  • Other Alkaloids: Interacting with serotonin system, which is involved in satiety centers and mood elevation. Also important for Pain processing.
  • Hitting Adeninuric receptors for stimulant type activity.

• Kratom - Pharmaceutical Shotgun:

  • Kratom is a complex symphony of chemicals that is playing multiple instruments in the brain at the same time.
  • Nature is pointing to multiple pathways being activated for increased relief.

• Potential Antifungal Properties:

  • Plants produce chemical defense that is protecting from fungus in hot and humid environments. The alkaloids also act as anti-feedant to make sure passing by animals are not going to eat the tree.

• White Vein vs Red Vein:

  • Most of the differences are marketing. There are five colors of the powders in products that are in the market that have to do with how they have been cured/dried after they have been harvested.

• Good Things About Nature/Natural Products:

  • Raw cacao, 100% Venezuelan chocolate, beans that have Polyphenol content. Eat the beans for fiber and taste (but get the clean versions that are not heavy with metals.)
  • Ethically sources beans are a good mark to look for.

• Soda:

  • Soda came about as alternative to hard alcohols in soda fountains.
  • 7up had lithium and helped with mood and wellness.
  • Coca-Cola contained cocaine. In fact, Coca-Cola is still a major importer of cocoa leaves.

• Coca Cola:

  • Still today, what makes Coke Zero the flavor is that it contains the cocoa lead extract.

• What's Happening with the Cocoa Lead Cocaine:

  • Cocoa leaves are processed to separate the alkaloids and sent to pharmaceutical companies which are processed into cocaine that is used for pharmaceutical companies.

• Potential Use forratom as an Antidepressant:

  • There needs to be studies done to investigate this more.

• How To Get Offratom:

  • Many professionals look atratom as something opiate like and prescribe opiate drugs like Suboxone and Methadone to help get them off.
  • This could actually make things worse.
  • Seek medical profession help from qualified providers.

• Advice Aboutratom (General):

  • Best way to avoid getting hooked, don't touch it.
  • Don't go it alone.

• Personal Anecdotes:

  • Pharmacist background. High school science fair project with caffeine.

This summary should provide a comprehensive overview of the key information and arguments presented in the video transcript.