AMA #9: Kratom Risks, Does Infrared Sauna Work & Journaling Benefits

00:00:00.000 | - Welcome to the Huberman Lab Podcast,

00:00:02.260 | where we discuss science and science-based tools

00:00:04.900 | for everyday life.

00:00:05.900 | I'm Andrew Huberman, and I'm a professor of neurobiology

00:00:12.260 | and ophthalmology at Stanford School of Medicine.

00:00:15.340 | Today is an Ask Me Anything episode or AMA.

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00:01:42.500 | So without further ado,

00:01:43.720 | let's get to answering your questions.

00:01:46.000 | The first question is about kratom.

00:01:47.980 | And the question is,

00:01:49.060 | what are the short and long-term effects of taking kratom?

00:01:52.700 | For those of you that haven't heard of kratom,

00:01:54.500 | kratom is a substance that comes from a tree

00:01:57.060 | that grows naturally in Indonesia.

00:01:59.300 | The tree itself is called Mitragyna speciosa.

00:02:02.980 | And it's been known for hundreds of years or more,

00:02:05.860 | we don't really know how long,

00:02:07.340 | but at least for a couple of hundred years,

00:02:10.220 | that when people chew the leaves of this tree,

00:02:13.220 | they experience a mild stimulant effect.

00:02:15.640 | And there's also a process of extraction

00:02:17.380 | whereby you can take the leaves

00:02:18.940 | and get high concentrations of kratom

00:02:21.700 | that nowadays is packaged into various supplements,

00:02:24.400 | most often consumed in capsule form,

00:02:26.520 | although sometimes it's sold in raw powder form.

00:02:29.820 | Here's the key thing to understand about kratom.

00:02:32.200 | Indeed, at low dosages, kratom has a mild stimulant effect.

00:02:35.900 | However, at higher dosages,

00:02:38.140 | it has what's called an analgesic effect,

00:02:40.340 | that is a pain killing effect,

00:02:42.740 | and it acts as a sedative.

00:02:45.060 | And kratom itself acts as an opioid in the body.

00:02:48.860 | This is what's making kratom

00:02:50.100 | a very controversial topic these days.

00:02:52.540 | In particular, because most people have heard

00:02:55.220 | of the so-called opioid crisis,

00:02:56.740 | the opioid crisis has been a term coined

00:03:00.160 | to largely center around issues

00:03:01.800 | that have taken place in the United States,

00:03:03.220 | although these issues definitely extend

00:03:05.660 | beyond the borders of the United States.

00:03:07.340 | But the opioid crisis is essentially the overconsumption

00:03:11.020 | and widespread addiction to opioids.

00:03:14.240 | Opioids include things like morphine, oxycodone,

00:03:17.820 | also called oxycontin,

00:03:19.460 | and there are other opioids similar to those compounds,

00:03:22.460 | all of which have the general effect

00:03:24.240 | of being painkillers and sedatives.

00:03:26.740 | And in some people, again,

00:03:28.260 | some people eliciting a sense of euphoria,

00:03:31.900 | in particular at low to moderate dosages.

00:03:34.340 | However, people quickly develop a tolerance to those drugs

00:03:37.780 | and need to consume more and more of them

00:03:40.000 | in order to get the effect that they initially got

00:03:42.500 | from a lower dosage.

00:03:43.860 | And they are not just highly habit forming,

00:03:46.180 | they are highly addictive.

00:03:47.500 | And we can distinguish between habit forming and addictive

00:03:50.700 | by simply saying that addictive means

00:03:53.060 | people will continue to take something

00:03:55.220 | or do something despite negative consequences.

00:03:58.520 | There are other relevant definitions of addiction as well.

00:04:00.980 | I define addiction more broadly

00:04:02.700 | as the progressive narrowing

00:04:04.980 | of the things that give you pleasure.

00:04:06.300 | And indeed, when people get addicted to opioids,

00:04:08.380 | it is a very bad picture.

00:04:10.540 | It often hampers many, many areas of their lives

00:04:13.340 | and seriously so.

00:04:15.140 | So the opioid crisis refers to the overprescription

00:04:18.300 | of opioid drugs.

00:04:20.000 | That's sort of what it's generally taken to mean,

00:04:22.060 | but it also includes accessing opioids

00:04:24.680 | such as morphine, oxycodone, et cetera,

00:04:27.340 | through gray market sources,

00:04:28.860 | through black market sources, and on and on.

00:04:31.920 | And of course, the acquisition of the drugs

00:04:34.120 | is just one piece.

00:04:35.100 | It's also the overconsumption of those drugs.

00:04:36.900 | And of course, the addiction to those drugs,

00:04:39.440 | which has proved to be so pernicious.

00:04:41.740 | So what does this have to do with kratom?

00:04:43.380 | Kratom is also an opioid,

00:04:45.620 | and we'll talk about how it differs

00:04:47.720 | in its opioid properties from the drugs I just talked about

00:04:50.140 | because it is different from morphine and hydrocodone,

00:04:54.180 | but it also has some similar properties as well.

00:04:57.060 | But the deal with kratom is that

00:04:59.460 | a good number of people out there

00:05:01.420 | have managed to wean themselves off opioids

00:05:04.540 | such as morphine and hydrocodone

00:05:06.580 | through the use of kratom.

00:05:08.700 | And that has been used as justification

00:05:11.220 | for keeping kratom on the market and keeping it legal.

00:05:13.660 | However, and this is a very important however,

00:05:17.100 | kratom itself has also proved to be

00:05:19.720 | not only habit forming, but addictive,

00:05:21.880 | especially when taken at dosages

00:05:24.120 | that exceed that lower dose

00:05:26.440 | that just generally creates a bit of stimulant,

00:05:28.920 | a little bit of euphoric effect.

00:05:30.660 | When people start taking higher dosages of kratom,

00:05:33.280 | it is very clear that it does become addictive

00:05:36.000 | and itself is very hard to come off of,

00:05:38.780 | so much so that people experience

00:05:40.260 | so-called kratom withdrawal.

00:05:41.860 | Now, the reason I mentioned that kratom has been used

00:05:43.600 | by a good number of people to wean themselves off of

00:05:46.940 | the more potent forms of prescription opioids

00:05:49.800 | is that when I solicited for questions about kratom

00:05:53.420 | on social media, it was a very binary response.

00:05:56.680 | In fact, there was one camp,

00:05:58.180 | a very rabid camp that said kratom is terrible,

00:06:01.280 | I took this stuff, I got addicted,

00:06:02.840 | it was extremely hard to come off of.

00:06:04.700 | There were additional comments in there

00:06:07.700 | such as I know somebody who literally had to go to rehab

00:06:10.480 | because of kratom, who developed a bunch of other addictions

00:06:13.320 | because of kratom, essentially many, many responses

00:06:16.000 | of people who had only bad experiences with kratom,

00:06:19.600 | meaning they liked it enough at first

00:06:22.900 | that they continued to take it

00:06:24.540 | and it became addictive for them

00:06:26.300 | or somebody that they know.

00:06:27.740 | However, there was another camp that was equally vocal,

00:06:30.300 | which kept saying, no, if one really adheres

00:06:32.900 | to the lower dosages of kratom,

00:06:34.340 | kratom itself can be a useful tool

00:06:36.180 | for getting off other opioids.

00:06:37.860 | And there were even a few bona fide medical professionals,

00:06:41.180 | medical doctors that is, and I happen to know them

00:06:44.040 | and their reputations is quite good,

00:06:45.860 | who chimed in and sort of reconciled the two camps

00:06:49.320 | by saying, indeed, if one can avoid taking kratom at all,

00:06:53.740 | you should.

00:06:54.720 | There is no reason to take this thing

00:06:56.320 | thinking that it's quote unquote good for you.

00:06:58.280 | You would be wise to avoid taking it

00:07:00.300 | because there is a high probability

00:07:02.860 | if you take it at a given dosage

00:07:04.940 | or at a dosage that is going to get your brain and body

00:07:08.320 | into a state of euphoria, analgesia,

00:07:11.820 | and that sort of classic opioid effect

00:07:14.880 | that it's going to become habit forming or addicting for you.

00:07:18.180 | That said, these same medical professionals acknowledged

00:07:21.260 | that a fair number of people that they knew

00:07:23.060 | managed to get off of the more potent forms of opioids,

00:07:26.560 | such as morphine, oxycodone, and so forth, using kratom.

00:07:30.200 | And they said, well, if it's a choice

00:07:31.560 | between being addicted to morphine and hydrocodone

00:07:33.800 | versus taking kratom and addicted to those substances,

00:07:36.540 | and kratom somehow allowed them

00:07:38.140 | to taper off of those substances,

00:07:40.380 | that they would look more favorably upon kratom

00:07:43.560 | if and only if they would also commit

00:07:47.160 | to progressively lowering their dose of kratom

00:07:49.260 | and eventually coming off of kratom.

00:07:51.340 | So the general takeaway from all of that

00:07:53.320 | is if you can avoid taking kratom,

00:07:55.360 | meaning if you haven't taken it already, don't.

00:07:57.660 | And that reminds me of a very important point,

00:07:59.800 | which a guest on the Huberman Lab podcast,

00:08:01.860 | Dr. Robert Merlanka, who's a MD and PhDs,

00:08:04.880 | my colleague at Stanford School of Medicine,

00:08:06.900 | is a world expert on the mechanisms underlying addiction

00:08:11.640 | and dopamine and drug reinforcement,

00:08:13.840 | among many other things.

00:08:15.700 | What he said on the podcast is absolutely true,

00:08:18.360 | which is that it is impossible to get addicted

00:08:20.980 | to a substance that you've never consumed.

00:08:23.480 | That might seem obvious, but think about that one again.

00:08:25.560 | It is impossible to get addicted

00:08:27.600 | to a substance that you've never consumed.

00:08:29.820 | So I think the safest statement to make

00:08:31.320 | is if you have not tried kratom,

00:08:33.480 | you would be wise to avoid it

00:08:34.940 | because you stand a chance to become addicted to it.

00:08:38.280 | If, however, you are somebody that's addicted

00:08:40.040 | to other forms of opioids,

00:08:41.400 | you absolutely should talk to your physician about that

00:08:43.960 | and how to get off of those opioids.

00:08:45.900 | But there is evidence that some people have used kratom

00:08:48.560 | to successfully wean themselves off

00:08:50.560 | the more potent forms of opioids that I talked about,

00:08:53.060 | namely morphine and hydrocodone, as well as a few others.

00:08:57.160 | Now, if you're somebody who already takes kratom,

00:09:00.300 | you need to be very thoughtful

00:09:01.760 | about the dosage that you take.

00:09:03.160 | And you also need to be thoughtful about the fact

00:09:05.280 | that people differ dramatically in their response to opioids.

00:09:09.120 | This is oh so important and people do not talk

00:09:11.920 | about this enough.

00:09:13.120 | We hear, for instance, that, oh, you know,

00:09:14.760 | if people are taking anywhere from one to five grams,

00:09:17.440 | maybe one to six grams of kratom per day,

00:09:20.000 | that's keeping it in the dosage range

00:09:22.120 | for which people don't generally tend to get addicted.

00:09:24.160 | You'll hear things like that.

00:09:25.300 | And by the way, when I say one to five

00:09:26.980 | or one to six grams per day,

00:09:28.880 | I'm not talking about the individual compounds

00:09:31.120 | that are present in kratom.

00:09:32.560 | There are a couple of different plant alkaloids

00:09:34.380 | I'll talk about in a moment that are present in kratom,

00:09:36.560 | and these have different effects on the opioid system.

00:09:39.200 | So nowadays, some of the companies that sell kratom,

00:09:41.640 | and by the way, this is sold over the counter

00:09:43.200 | as a supplement.

00:09:44.040 | It does not require a prescription to purchase,

00:09:46.200 | at least at this point in time in the United States.

00:09:48.320 | Some of these products will have a higher concentration

00:09:51.480 | of one or the other alkaloids within them,

00:09:54.260 | such that you can't really compare one gram

00:09:56.560 | of one brand of kratom to one gram of another brand

00:10:01.280 | of kratom because they can have wildly different levels

00:10:04.280 | of these different alkaloids, and these different alkaloids

00:10:06.820 | have wildly different impact on different aspects

00:10:10.240 | of your brain and body biology.

00:10:12.660 | In particular, how much they tend to impact

00:10:15.100 | the so-called endogenous opioid system.

00:10:17.700 | Okay, so when we talk about dosages,

00:10:19.320 | we have to keep this in the back of our mind,

00:10:20.920 | and we have to keep in the back of our mind

00:10:23.260 | that there does seem to be a subgroup of people.

00:10:26.440 | We don't know how big this subgroup of people is,

00:10:28.640 | but we know it's not everyone,

00:10:30.600 | but it's somewhere between 10 and 40% of people

00:10:34.300 | seem to respond to opioids in a particularly potent way.

00:10:38.040 | They really like them, and perhaps not surprisingly,

00:10:42.280 | people outside of that category don't tend to like opioids.

00:10:45.360 | I can certainly say that I am somebody who,

00:10:47.960 | when I've been prescribed things like Vicodin

00:10:50.440 | or any other opioid post-surgery for pain,

00:10:54.200 | I hate taking those drugs.

00:10:55.880 | I absolutely hate it.

00:10:57.080 | I'd rather deal with the pain.

00:10:58.520 | They make me nauseous, they make me feel terrible.

00:11:01.880 | That said, I know people who love opioids.

00:11:05.680 | It's like a natural fit for their chemistry

00:11:08.760 | in the sense that it tends to evoke more euphoria.

00:11:11.200 | They just immediately like the feeling.

00:11:13.340 | Some of you may remember the episode

00:11:14.800 | of the Huberman Lab podcast that I did about alcohol,

00:11:17.560 | and there too, I discussed the fact

00:11:19.760 | that about eight to 10% of people who consume alcohol

00:11:23.040 | get an increased dopamine response to alcohol

00:11:26.160 | that's not observed in other people,

00:11:28.200 | and that particular subgroup of people is very,

00:11:31.800 | very at risk for developing alcohol use disorder,

00:11:34.520 | sometimes called alcoholism, because they can drink in a way

00:11:38.800 | and they experience a high from drinking in a way

00:11:42.280 | that other people simply do not experience.

00:11:45.240 | Now, like everybody else,

00:11:46.160 | if they consume too much alcohol, they get drunk,

00:11:48.440 | so it's not about the drunk effect.

00:11:50.360 | It's about the dopamine and other sorts of chemicals

00:11:53.440 | that are released in those people in response to alcohol

00:11:55.820 | that other people just don't seem to experience

00:11:58.480 | at the same level of potency.

00:12:00.980 | So again, with things like kratom and the other opioids,

00:12:03.980 | there's a category of people,

00:12:04.820 | and it's a much larger category of people.

00:12:06.840 | Again, 10 to 40%, we don't know exactly how many

00:12:09.440 | because the studies are not really completed

00:12:11.700 | and there aren't enough of those studies yet, unfortunately,

00:12:14.120 | but when those people take an opioid, wow, oh wow,

00:12:17.960 | do they like it, and those people in particular

00:12:20.960 | are very much at risk for developing an addiction

00:12:24.400 | to opioids, and so those people especially

00:12:27.240 | should never ever go near kratom if they haven't,

00:12:30.320 | or if they are already taking kratom,

00:12:32.440 | these are the people that are constantly ratcheting up

00:12:34.760 | their dose, these are the people that tell you,

00:12:37.100 | no, I'm not addicted, but if you were to say,

00:12:39.120 | hey, all right, well then let's do an experiment

00:12:40.980 | where you don't take kratom for a week.

00:12:43.060 | Those are going to be the people that are suddenly going

00:12:45.220 | to get anxious about the mere idea of that.

00:12:47.540 | I've also talked about this in reference to cannabis

00:12:50.000 | when I did an episode about cannabis.

00:12:52.040 | Again, I'm not putting a blanket statement out there

00:12:54.040 | about cannabis as being good or bad on that episode.

00:12:56.680 | I talked about the fact that cannabis does indeed

00:12:58.760 | have various therapeutic uses, but that there are a good

00:13:02.760 | number of people who rely on cannabis for anxiety control

00:13:05.680 | and other ways of modulating their brain chemistry

00:13:09.720 | and bodily chemistry such that if you were to say,

00:13:11.920 | hey, are you addicted to cannabis?

00:13:13.320 | They'd say, no, I don't have to smoke cannabis,

00:13:15.020 | I don't have to take my edibles, but if you were to push

00:13:17.820 | them a little bit and say, all right, well then,

00:13:20.160 | let's do an experiment where you don't consume any cannabis

00:13:23.600 | in any form for 10 days.

00:13:25.860 | They don't like the idea of that experiment at all.

00:13:28.440 | So much so that were they to run that experiment,

00:13:30.960 | they would experience a lot of the withdrawal symptoms

00:13:33.160 | associated with addiction.

00:13:35.800 | So I can't in good faith say that kratom is safe

00:13:38.720 | for everybody because it is simply not.

00:13:40.920 | Now, is it safer than the other opioids?

00:13:43.560 | And if so, why?

00:13:44.880 | Well, in order to address that, let's take a short glance

00:13:47.220 | at the pharmacology of kratom and how it works in terms

00:13:50.440 | of its neurochemistry in the body.

00:13:52.040 | And I'm going to keep this pretty brief

00:13:53.200 | because in the future, I'm going to do an extended episode

00:13:55.640 | all about opioids and I will include kratom

00:13:58.120 | in that conversation.

00:13:59.440 | But just to back up a little bit and discuss

00:14:02.880 | what opioids are, opioids are compounds that can activate

00:14:07.160 | the so-called endogenous opioid system.

00:14:09.600 | All of us have within our brain and body,

00:14:12.120 | the capacity to release our own opioids.

00:14:15.560 | That's right, you have opioids within your body,

00:14:17.880 | they are released from neurons and they bind

00:14:20.160 | to so-called opioid receptors.

00:14:22.520 | Perhaps some of you have heard

00:14:23.440 | of the so-called runner's high.

00:14:25.140 | The runner's high is a euphoric state.

00:14:28.000 | It's a fairly mild euphoric state in most cases,

00:14:30.360 | but it's a euphoric state induced by long duration effort,

00:14:34.960 | AKA the runner's high.

00:14:36.880 | The runner's high is just a phrase used to explain

00:14:39.480 | that when we engage in long duration,

00:14:41.980 | repetitive action effort,

00:14:44.460 | the body starts releasing these endogenous opioids,

00:14:47.120 | they bind to receptors and they trigger things

00:14:49.240 | like analgesia, relief from pain.

00:14:51.780 | They trigger mild euphoria.

00:14:53.500 | They tend to change our perception of the outside world,

00:14:55.560 | make things look more beautiful, shiny.

00:14:57.980 | They give things a little bit of a sheen.

00:15:00.080 | What I just described is a mild version

00:15:02.680 | of what people experience

00:15:03.760 | when they take something like morphine.

00:15:05.640 | When people take morphine,

00:15:06.620 | there's a more of a sedative effect,

00:15:08.440 | there's more of a euphoric effect,

00:15:10.360 | and there's more of a dreamlike effect.

00:15:11.840 | And again, it will depend on dosage.

00:15:13.440 | Kratom and morphine and hydrocodone all have the property

00:15:18.280 | of acting like the endogenous opioids,

00:15:22.100 | but at much higher potency.

00:15:24.740 | When you bring them into your system,

00:15:26.400 | they cross the blood-brain barrier,

00:15:28.040 | so they go into the brain,

00:15:29.420 | and they bind to a number of different opioid receptors.

00:15:33.220 | There's the mu opioid receptor.

00:15:35.660 | By the way, these names all follow Greek alphabet letters.

00:15:38.820 | So the mu opioid receptor, the kappa opioid receptor,

00:15:41.820 | there are a bunch of different ones.

00:15:44.060 | Kratom binds preferentially to the mu opioid receptor

00:15:48.020 | and somewhat to the kappa opioid receptor.

00:15:50.500 | There's a big misconception out there.

00:15:51.740 | A lot of people,

00:15:52.580 | especially people who are proponents of kratom,

00:15:54.740 | will say no, morphine and hydrocodone

00:15:57.740 | bind the mu opioid receptor,

00:15:59.740 | whereas kratom binds the kappa opioid receptor,

00:16:02.000 | so it's a different compound, very, very different.

00:16:04.820 | Not true, not true.

00:16:07.680 | Kratom, morphine, and hydrocodone

00:16:10.280 | all bind to the mu opioid receptor,

00:16:12.860 | and that's what's largely responsible

00:16:14.880 | for its opioid-like effects,

00:16:17.620 | especially when you get the dosage up to a level

00:16:20.560 | where you start getting the mild sedation,

00:16:22.420 | the analgesia, the pain relief.

00:16:23.920 | And keep in mind, a lot of people are taking kratom

00:16:26.600 | because they want pain relief.

00:16:28.620 | And when that mu opioid receptor system is activated,

00:16:31.740 | it indirectly activates

00:16:33.340 | a lot of the reinforcement circuitry in the brain

00:16:36.300 | that relates to dopamine and serotonin.

00:16:38.520 | This is another area

00:16:39.460 | that we'll go into in more depth in the future,

00:16:41.360 | but there's been a lot of controversy.

00:16:42.540 | People saying, oh, kratom doesn't trigger

00:16:45.140 | the dopamine system, therefore it's not addictive.

00:16:47.420 | But that is simply not true.

00:16:48.420 | It indirectly activates the reinforcement circuitry

00:16:50.700 | that includes both dopamine and serotonin,

00:16:53.100 | but its primary effect

00:16:54.100 | is to hit this mu opioid receptor system

00:16:56.820 | that exists in a bunch of places in the brain,

00:16:58.900 | but mainly in the brainstem

00:17:00.020 | and a structure called the periaqueductal gray nucleus,

00:17:02.280 | which then provides pain relief.

00:17:04.700 | It triggers a number of different shifts in cognition.

00:17:07.780 | It's what creates that mild euphoria, et cetera, et cetera.

00:17:11.260 | Now, how can we be so confident

00:17:13.360 | that kratom is acting so similarly to hydrocodone

00:17:17.300 | and to morphine, albeit with lower potency?

00:17:20.400 | And the reason is if you give people a drug

00:17:22.440 | that blocks the mu opioid receptor

00:17:24.340 | prior to them taking kratom,

00:17:26.100 | they don't experience any of the classic effects

00:17:29.020 | of taking kratom.

00:17:30.520 | No euphoria, no analgesia, no sedation,

00:17:33.880 | even at the low dosages, no mild stimulant effect.

00:17:37.500 | So we really have to look at kratom as an opioid, okay?

00:17:41.700 | That's just the honest truth.

00:17:42.900 | And if you're somebody who doesn't like this message

00:17:44.580 | because you like kratom,

00:17:46.460 | I'm not telling you that you don't like kratom.

00:17:48.240 | I'm telling you, you likely like kratom

00:17:49.800 | because it's an opioid.

00:17:51.300 | So again, if you go online

00:17:52.540 | and you start asking questions about kratom,

00:17:54.740 | again, you're going to see these two camps.

00:17:56.420 | You're going to see the kratom is terrible,

00:17:59.540 | it's addictive, it's everything bad camp.

00:18:01.900 | And then you're going to see the other camp out there,

00:18:04.540 | very vocal as well,

00:18:06.000 | talking about how kratom helped them

00:18:07.940 | avoid other things that are worse.

00:18:09.660 | And this is an argument that frankly,

00:18:12.700 | I don't think we want to lean on, right?

00:18:14.620 | The idea that substance A is not as bad as substance B

00:18:18.780 | and that making substance A unavailable

00:18:21.620 | is just going to send everyone running for substance B,

00:18:24.620 | you know, that's a weak argument, frankly, right?

00:18:27.740 | I heard this argument around cannabis.

00:18:29.420 | And by the way, I'm,

00:18:30.620 | I think pretty balanced about cannabis.

00:18:32.240 | If you listen to the episode I did on cannabis,

00:18:34.020 | I think you'll agree that I believe

00:18:36.060 | that cannabis has its therapeutic applications.

00:18:38.500 | I also believe that young people,

00:18:41.480 | especially young males with a predisposition to psychosis

00:18:44.460 | should not be taking high concentration THC cannabis,

00:18:47.660 | because the data tell us

00:18:48.840 | they are already at risk of psychosis

00:18:51.160 | and they are at a much greater risk of psychosis if they do.

00:18:53.860 | So I think I'm pretty balanced about the story on cannabis,

00:18:57.420 | but I often hear the argument,

00:18:59.020 | oh, cannabis isn't as bad as alcohol

00:19:01.120 | and therefore cannabis is good.

00:19:03.040 | That's simply not rational.

00:19:05.540 | What we should be saying is whether or not it's cannabis

00:19:07.620 | or alcohol or kratom or any substance for that matter,

00:19:10.980 | what are the potential benefits?

00:19:12.980 | What are the potential risks?

00:19:14.820 | And again, this is far too much

00:19:16.760 | than we can go into in this AMA.

00:19:18.900 | And we will go into in a future full length episode

00:19:21.360 | of the Huberman Lab podcast.

00:19:22.820 | But the other thing to really keep in mind

00:19:24.980 | is the lack of regulation over kratom supplements.

00:19:29.140 | Now, as many of you know, I am a fan of many, not all,

00:19:32.520 | but many supplements in certain conditions.

00:19:34.900 | I always say behaviors first, then nutrition,

00:19:37.940 | then if and only if it's needed, rely on supplementation.

00:19:41.980 | But supplementation is a big category.

00:19:44.460 | But when we're talking about supplements

00:19:46.120 | that are opioid compounds, I start to get nervous

00:19:48.740 | because of the high abuse potential

00:19:51.060 | and the high addiction potential of opioids.

00:19:55.020 | And kratom is included in that category.

00:19:57.180 | A couple of other key notes about kratom.

00:19:59.720 | While death directly from kratom is fairly rare,

00:20:03.020 | it has happened.

00:20:04.680 | Now, hydrocodone and morphine suppress respiration,

00:20:08.780 | actually suppress breathing by way of a mechanism

00:20:11.400 | that if you're a listener of the Huberman Lab podcast,

00:20:13.980 | you know about, which is the so-called physiological sigh.

00:20:17.120 | Many of you have heard me talk about the physiological sigh

00:20:19.460 | as something that you do voluntarily,

00:20:20.980 | the double inhale through the nose and then a long exhale

00:20:23.620 | in order to rapidly reduce your level of stress.

00:20:26.140 | As far as we know, that's the fastest way

00:20:28.020 | to deliberately lower your level of stress.

00:20:30.980 | But the physiological sigh was discovered in the 1930s

00:20:34.220 | as a spontaneous pattern of breathing

00:20:36.400 | that occurs involuntarily in sleep

00:20:39.820 | in order to reinflate the lungs and offload carbon dioxide

00:20:42.520 | and bring oxygen back into the system

00:20:44.260 | on the subsequent breath.

00:20:45.680 | When I interviewed Dr. Jack Feldman,

00:20:47.400 | who is a professor at University of California, Los Angeles,

00:20:50.320 | and really the pioneer

00:20:51.960 | of the modern neuroscience understanding of respiration,

00:20:54.920 | he talked about some studies in his laboratory

00:20:56.960 | that were exploring why people die when taking opioids.

00:21:01.400 | This is a major issue associated with the opioid crisis.

00:21:03.960 | And what he mentioned was that the opioids bind

00:21:06.640 | to particular receptors in the brainstem locations

00:21:10.100 | that generate physiological sighs.

00:21:12.940 | So opioids, when taken as drugs,

00:21:15.760 | suppress physiological sighing and do so during sleep.

00:21:19.980 | And lack of adequate respiration,

00:21:22.240 | meaning people stop breathing during sleep,

00:21:24.560 | is one of the primary reasons why people die

00:21:26.940 | when they take opioids.

00:21:28.880 | Now, kratom is not known to suppress respiration

00:21:31.340 | when taken at low to moderate dosages,

00:21:33.740 | but when combined with any other opioids,

00:21:36.860 | and certainly when combined with alcohol,

00:21:39.040 | it can suppress respiration.

00:21:41.160 | And while the data on this are fairly scant,

00:21:43.940 | there is some evidence that kratom-induced death

00:21:46.540 | is caused by suppression of the respiration system.

00:21:49.900 | So again, death due to taking kratom

00:21:52.980 | at the dosages that are recommended

00:21:54.800 | on most commercial packaging is fairly rare,

00:21:57.720 | although it has happened.

00:21:59.660 | It's unclear if it happened

00:22:00.760 | because it was taken in combination with other compounds.

00:22:03.300 | That seems likely,

00:22:04.500 | but we can't forget that a lot of people

00:22:05.780 | are taking kratom at much higher dosages,

00:22:08.340 | and in fact, progressively higher and higher dosages

00:22:11.320 | from these over-the-counter sources.

00:22:13.580 | And with increased dosage,

00:22:15.700 | there is, yes, an increased risk of respiratory failure.

00:22:19.660 | So again, all of this points to the fact

00:22:22.160 | that kratom is simply not a benign substance.

00:22:24.760 | So if we're going to be very honest,

00:22:27.020 | the addictive potential of kratom is real.

00:22:29.580 | It is exacerbated for some people compared to others,

00:22:33.380 | but it is real.

00:22:34.820 | Its very similarities to other more potent forms of opioids

00:22:38.580 | are what make it attractive for some people

00:22:40.480 | who are trying to come off

00:22:41.440 | those more potent form of opioids.

00:22:43.620 | But the goal, of course,

00:22:45.360 | is to completely come off all opioids.

00:22:47.700 | And kratom itself can be a bit of a trap.

00:22:50.740 | It can be a trap in the sense

00:22:52.240 | that people who have never taken other opioids

00:22:54.700 | can become addicted to kratom itself.

00:22:56.640 | That is absolutely clear.

00:22:57.820 | That can happen.

00:22:58.900 | It has happened in a great number of people.

00:23:01.760 | It's also clear that kratom can potentially be a trap.

00:23:04.280 | Notice I said potentially,

00:23:05.780 | because if people are trying to come off

00:23:08.020 | other more potent forms of opioids,

00:23:09.700 | and then they use kratom to do that,

00:23:11.300 | and then they're ratcheting up their dosage of kratom

00:23:14.320 | such that they're now matching the endogenous response

00:23:18.140 | to kratom in a way that doesn't really distinguish

00:23:21.460 | from the effects that they were getting

00:23:23.080 | from morphine and hydrocodone,

00:23:25.040 | well, then they're just using a different form

00:23:28.380 | of morphine and hydrocodone.

00:23:29.900 | And I'm sure that some of you are out there saying,

00:23:32.180 | that is ridiculous.

00:23:33.560 | You cannot compare the effects of kratom

00:23:35.620 | to the effects of hydrocodone.

00:23:36.820 | But the potency is about 1/6 of hydrocodone.

00:23:40.180 | And there are people out there who are just increasing

00:23:42.380 | and increasing both the dosage

00:23:46.220 | and modifying the type of kratom that they're taking

00:23:49.180 | so that they're getting the kratom

00:23:50.380 | that has a particularly high concentration

00:23:53.020 | of one of the alkaloids

00:23:54.740 | that hits that mu opioid receptor hardest.

00:23:58.140 | And in doing so, sure,

00:23:59.960 | they're not getting the pure hydrocodone effect,

00:24:02.540 | but they're getting really close.

00:24:04.060 | So my advice would be, if you haven't touched kratom,

00:24:06.620 | don't touch it at all, ever.

00:24:08.740 | If you are taking kratom,

00:24:10.520 | you need to take note of what we just discussed.

00:24:12.720 | Thank you for joining

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AMA #9: Kratom Risks, Does Infrared Sauna Work & Journaling Benefits

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