Let us start at the beginning with a list of dietary supplements that are not regulated in the United States (because, for the most part, herbal and dietary supplements are not regulated) and, for this reason among others, can be harmful–even deadly:
Herbs ranked in the top five categories having potentially life-threatening side-effects include, but are not limited to: Liver Toxicity — celandine, chaparal, comfrey, Dai-saiko-to, germander, groundsel, Hathisunda, Impila, Jin bu huan (JBH), kava, mistletoe, pennyroyal, senna, and skullcap; Renal Toxicity — Guang fang ji, mu tong, and Tenshin Tokishigyaku-ka-goshuyu-shokyo-to; Cardiotoxic — chuanwu, foxglove, henbane, Jin bu huan, licorice, lily of the valley, ma huang, and squill; Carcinogenic — guang fang ji, coltsfoot, comfrey, madder root, mate, and sassafras; and; Deaths — chuanwu, germander, hemlock, henbane, jimsonweed, licorice, Ma huang, oleander, penyroyal, Sho-saiko-to, and wintergreen (oil). (Note: This “Harmful Herb List” represents the first draft of a manuscript that includes Tables 1-5. The sources of these tables were compiled from: Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. Medical Economics Company, 2000; DerMarderosian A. The Review of Natural Products. Facts and Comparisons, 2000; assorted Medline articles.) (Brown 2002).
The above list should be enough to make consumers wary. At the least, they should be careful; at the greatest, they should do due diligence–and I mean real due diligence–not a Google search that may or may not tell how dietary supplements might negatively impact your health.
Kratom is a dietary supplement. Its scientific name is Mitragyna speciosa (Rubiaceae) and it comes from a tropical tree. In many parts of Africa and Southeast Asia, it has a history of medicinal use (Warner et al. 2016). When taken at high doses, it acts like an opioid. In several cases, this opioid effect can be fatal.
A study of 15 kratom-related deaths in Colorado from 1999 through 2017 included comprehensive toxicologic screening (Gershman et al. 2019). Fifteen kratom related deaths. This is just the tip of the iceberg. Check out the titles for other research articles on how this herbal (dietary) supplement interacted with a number of individuals:
Deaths in Colorado Attributed to Kratom (Gershman et al. 2019)
Unintentional Fatal Intoxications with Mitragynine and O-desmethyltramadol from the Herbal Blend Krypton (Kronstrand et al. 2011)
Mitragynine ‘Kratom’ Related Fatality: A Case Report with Postmortem Concentrations (McIntyre et al. 2015)
A Drug Fatality Involving Kratom (Neerman et al. 2012)
Enough! Obviously, by this point in this series, both herbal and dietary supplements can and, indeed do, cause death. But even if you do due diligence and serious research–this still may not be enough. Check this out:
In The Journal of Medical Toxicology, Lydecker et al. (2016) discovered something that due diligence will not be able to uncover.
We purchased several commercially available Kratom analogs for analysis and through our results, present evidence of probable adulteration with the highly potent and addictive plant alkaloid, 7-hydroxymitragynine.
We have found multiple packaged commercial Kratom products likely to contain artificially elevated concentrations of 7-hydroxymitragynine, the alkaloid responsible for M. speciosa’s concerning mechanistic and side effect profile. This study describes a unique form of product adulteration, which stresses the importance of increased dietary supplement oversight of Kratom-containing supplements.
That’s right. “We…found multiple packaged commercial Kratom products…[with] artificially elevated concentrations of 7-hydroxymitragynine, the alkaloid responsible for M. speciosa’s concerning mechanistic and side effect profile.” Somethings are worth repeating.
So what can we, as consumers, do?
Yes, nothing, because kratom, like so many other herbal and dietary supplements are not regulated. Did I not already make this point clear?
Can this be one primary reason why people do die from these so called healthy nonthreatening supplements?
Of course, it is.
Brown AC. Potentially life-threatening herbs: reported cases in MEDLINE of liver toxicity, renal toxicity, cardiotoxicity, cancer, and death. Poster Presentation at Experimental Biology, New Orleans, Louisiana, United States. 2002.
By Michael H. Brownstein