Podcast Summary: Huberman Lab – Health Effects & Risks of Kratom, Opioids & Other Naturally Occurring Medicines | Dr. Chris McCurdy
Introduction
In this episode of the Huberman Lab podcast, host Andrew Huberman, a neuroscientist and professor at Stanford School of Medicine, engages in an in-depth conversation with Dr. Chris McCurdy, a professor of Medicinal Chemistry at the University of Florida. Dr. McCurdy directs research on natural products and their pharmacologic effects, with a primary focus on Kratom—a plant-derived compound gaining significant usage in the United States and globally.
Understanding Kratom
Timestamp: [03:46]
Dr. McCurdy begins by explaining that Kratom, scientifically known as Mitragyna speciosa, is a tree native to Southeast Asia, particularly where Peninsular Malaysia and Thailand meet. Traditionally, farmers and outdoor laborers in this region have used Kratom leaves to brew teas or chew them directly to boost energy, enhance stamina, and suffer through harsh working conditions. Additionally, Kratom has been used to treat pain, erectile dysfunction, and elevate mood.
Notable Quote:
"It's a paradoxical description of Kratom, where you get this stimulant effect at lower doses or smaller amounts, and you get this more euphoric or sedative-like opioid effect at higher doses." – Dr. Chris McCurdy [03:46]
Kratom in the United States
Timestamp: [10:08]
In the U.S., Kratom products are widely available in supermarkets, convenience stores, and online, often marketed for specific effects like energy enhancement, pain management, or mood improvement. However, modern Kratom products differ significantly from traditional uses, primarily due to processing methods that concentrate the active compounds.
Product Variations:
- Traditional Products: Freshly harvested leaves used to make tea or chew directly.
- Modern Products: Dried and ground leaves incorporated into capsules, powders, or energy shots, often concentrated or extracted, altering their pharmacokinetic profiles.
Notable Quote:
"All Kratom products get dumped into a single bucket, whether or not it's a benign product or something that's highly concentrated." – Dr. Chris McCurdy [15:59]
Effects of Kratom: Dose-Dependent Actions
Timestamp: [22:47]
Kratom exhibits dose-dependent effects:
- Low Doses: Act as a stimulant, providing energy and focus similar to caffeine.
- High Doses: Transition into sedative and euphoric effects, akin to opioid usage.
This duality has led to varied usage patterns among consumers, with some using it as an energy booster while others seek pain relief or mood enhancement.
Notable Quote:
"If you're utilizing it over a course of time, you naturally think you got to take more to benefit from it." – Dr. Chris McCurdy [73:02]
Addiction and Dependence Potential
Timestamp: [30:49]
Dr. McCurdy emphasizes that Kratom can cause physical dependence with regular use, though occasional use does not typically lead to dependence. Users may experience withdrawal symptoms similar to caffeine or more severe, opioid-like symptoms such as headaches and anxiety when discontinuing use.
Notable Quote:
"The physical dependence feeling that most people will report is very similar to that of caffeine withdrawal or physical dependence on caffeine." – Dr. Chris McCurdy [31:06]
Kratom vs. Opioids: Usage and Risks
Timestamp: [36:21]
A significant portion of Kratom users in the U.S. utilize it as an alternative to traditional opioids, aiming to manage addiction or reduce opioid intake. However, there are concerns:
- Kratom Derived Products and Isolates: These are more potent and can lead to respiratory depression similar to opioids.
- Regulation Issues: Lack of clear differentiation and labeling in the market leads to unintentional overconsumption and increased risks.
Notable Quote:
"Our discussions about Kratom also open up a broader discussion about other plant alkaloids that have medicinal properties." – Andrew Huberman [36:58]
Regulatory and Safety Concerns
Timestamp: [66:21]
Dr. McCurdy highlights the complexities in regulating Kratom:
- Serving Sizes: Consumers often overlook serving sizes on packaging, leading to unintentional overconsumption.
- Product Classification: The market does not clearly distinguish between traditional leaf products and concentrated extracts or isolates, posing safety risks.
Notable Quote:
"It's extremely important to understand how to navigate this space because it’s not one thing, it’s just not." – Dr. Chris McCurdy [67:55]
Historical Context: Lessons from Coca Cola and Natural Products
Timestamp: [130:00]
Drawing parallels with historical examples, Dr. McCurdy discusses how natural products often contain multiple active compounds that work synergistically. He cites the example of Coca Cola, which originally contained extracted cocaine from coca leaves but later removed the psychoactive components while retaining flavoring agents.
Notable Quote:
"Most of us, including myself, run in and we pick up a prescription or we pick up something over the counter and don't even think twice about it." – Dr. Chris McCurdy [56:37]
Broader Implications: Natural Products in Medicine
Timestamp: [132:00]
The conversation extends to the role of natural products in modern medicine, emphasizing that many FDA-approved medications originate from or are modified from natural compounds. Examples include:
- Morphine: Derived from the opium poppy.
- Aspirin: Originates from salicylic acid found in willow bark.
- GLP-1 Agonists: Derived from compounds found in the saliva of the Gila monster.
Dr. McCurdy advocates for a balanced understanding of natural products, recognizing both their therapeutic potential and associated risks.
Notable Quote:
"There's just a lot of this out there. A couple of days ago I asked my ex audience, does anyone have any questions about Kratom?" – Andrew Huberman [Final Remarks]
Current Research and Future Directions
Timestamp: [118:01]
Dr. McCurdy shares insights into ongoing research efforts to isolate and understand individual alkaloids within Kratom, aiming to delineate their specific effects on various neurotransmitter systems, including:
- Opioid Receptors: Mitragynine interacts weakly, not providing strong analgesia.
- Serotonergic System: Influences mood and pain processing.
- Adrenergic Receptors: Contributes to stimulant effects.
He underscores the need for controlled clinical trials to fully comprehend the benefits and risks of Kratom, especially concerning its use in managing opioid dependence and potential for abuse.
Notable Quote:
"Kratom is a complex natural product with all these other alkaloids in it. And this is what makes Kratom different." – Dr. Chris McCurdy [Start of detailed alkaloid discussion]
Conclusion
The episode provides a nuanced perspective on Kratom, highlighting its potential as both a therapeutic agent and a substance with significant risks. Dr. McCurdy emphasizes the importance of proper regulation, informed usage, and continued research to harness Kratom's benefits while mitigating its dangers. The discussion also serves as a broader reflection on the intricate relationship between natural products and modern medicine, advocating for a thoughtful and informed approach to integrating plant-based compounds into healthcare.
Closing Quote:
"There may be benefits, indeed, but there's risks and there's potentially harm and we've got to figure out where each of those lie." – Dr. Chris McCurdy [160:19]
Key Takeaways:
- Kratom's Dual Effects: Acts as a stimulant at low doses and exhibits opioid-like sedative effects at higher doses.
- Product Variation Matters: Traditional leaf products differ significantly from modern concentrates and isolates in terms of potency and safety.
- Potential for Dependence: Regular use can lead to physical dependence, with withdrawal symptoms akin to caffeine or opioids.
- Regulatory Challenges: Lack of clear labeling and product differentiation poses risks for consumers.
- Natural Products in Medicine: Many effective medications originate from or are inspired by natural compounds, underscoring the importance of understanding their complex interactions within the body.
- Need for Research: Comprehensive studies are essential to unravel the full spectrum of Kratom's effects, benefits, and risks.
This episode serves as a crucial resource for those seeking to understand Kratom's role in health and medicine, offering insights grounded in scientific research and practical considerations.