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

ANDREW HUBERMAN: Welcome to the Huberman Lab podcast,

where we discuss science and science-based tools

for everyday life.

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I'm Andrew Huberman, and I'm a professor

of neurobiology and ophthalmology

at Stanford School of Medicine.

Today is an Ask Me Anything episode or AMA.

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So without further ado, let's get

to answering your questions.

The first question is about kratom.

And the question is, what are the short and long-term effects

of taking kratom?

For those of you that haven't heard of kratom,

kratom is a substance that comes from a tree that

grows naturally in Indonesia.

The tree itself is called mitragyna speciosa.

And it's been known for hundreds of years or more.

We don't really know how long, but at least for a couple

of hundred years, that when people chew

the leaves of this tree, they experience a mild stimulant

effect.

And there's also a process of extraction

whereby you can take the leaves and get high concentrations

of kratom that nowadays is packaged

into various supplements.

Most often consumed in capsule form,

although sometimes it's sold in raw powder form.

Here's the key thing to understand about kratom.

Indeed at low dosages, kratom has a mild stimulant effect.

However, at higher dosages, it has

what's called an analgesic effect, that

is a painkilling effect, and it acts as a sedative.

And kratom itself acts as an opioid in the body.

This is what's making kratom a very controversial topic

these days.

In particular, because most people

have heard of the so-called opioid crisis.

The opioid crisis has been a term

coined to largely center around issues

that have taken place in the United States,

although these issues definitely extend

beyond the borders of the United States.

But the opioid crisis is essentially

the overconsumption and widespread addiction

to opioids.

Opioids include things like morphine,

oxycodone, also called OxyContin,

and there are other opioids similar to those compounds,

all of which have the general effect of being painkillers

and sedatives.

And in some people, again some people,

eliciting a sense of euphoria in particular

at low to moderate dosages.

However, people quickly develop a tolerance to those drugs

and need to consume more and more of them

in order to get the effect that they initially

got from a lower dosage.

And they are not just highly habit-forming.

They are highly addictive.

And we can distinguish between habit

forming and addictive by simply saying that addictive means

people will continue to take something or do something

despite negative consequences.

There are other relevant definitions of addiction

as well.

I define addiction more broadly as the progressive narrowing

of the things that give you pleasure.

And indeed, when people get addicted to opioids,

it is a very bad picture.

It often hampers many, many areas of their lives,

and seriously so.

So the opioid crisis refers to the overprescription

of opioid drugs.

That's sort of what it generally taken to mean.

But it also includes accessing opioids such as morphine,

oxycodone, et cetera through gray market sources through,

black market sources, and on and on.

And of course, the acquisition of the drugs

is just one piece it's also the over consumption

of those drugs and, of course, the addiction to those drugs,

which has proved to be so pernicious.

So what does this have to do with kratom?

Kratom is also an opioid.

And we'll talk about how it differs

in its opioid properties from the drugs I just talked about

because it is different from morphine and hydrocodone,

but it also has some similar properties as well.

But the deal with kratom is that a good number

of people out there have managed to wean themselves

off opioids such as morphine and hydrocodone

through the use of kratom.

And that has been used as justification

for keeping kratom on the market and keeping it legal.

However, and this is a very important however,

kratom itself has also proved to be not only habit forming

but addictive, especially when taken at dosages that exceed

that lower dose that just generally creates

a bit of stimulant, a little bit of euphoric effect.

When people start taking higher dosages of kratom,

it is very clear that it does become addictive,

and itself is very hard to come off of,

so much so that people experience so-called kratom

withdrawal.

Now the reason I mentioned that kratom

has been used by a good number of people

to wean themselves off of the more potent forms

of prescription opioids is that when

I solicited for questions about kratom on social media,

it was a very binary response.

In fact, there was one camp a very rabid camp

that said kratom is terrible.

I took this stuff.

I got addicted.

It was extremely hard to come off of.

There were additional comments in there,

such as I know somebody who literally

had to go to rehab because of kratom who

developed a bunch of other addictions because of kratom.

Essentially many, many responses of people who had only bad

experiences with kratom.

Meaning they liked it enough at first

that they continued to take it, and it became addictive

for them or somebody that they know.

However, there was another camp that was equally vocal,

which kept saying no if one really adheres to the lower

dosages of kratom, kratom itself can

be a useful tool for getting off other opioids.

And there were even a few bona fide medical professionals,

medical doctors that is, and I happen to know them

and their reputations as quite good, who chimed in and sort of

reconciled the two camps by saying

indeed, if one can avoid taking kratom at all, you should.

There is no reason to take this thing thinking that it's

quote-unquote good for you.

You would be wise to avoid taking it

because there is a high probability if you take it

at a given dosage or at a dosage that is going to get your brain

and body into a state of euphoria, analgesia,

and the sort of classic opioid effect

that it's going to become habit forming or addicting for you.

That said, these same medical professionals

acknowledged that a fair number of people that they knew

managed to get off of the more potent forms of opioids

such as morphine, oxycodone, and so forth using kratom.

And they said, well if it's a choice between being

addicted to morphine and hydrocodone versus taking

kratom and addicted to those substances and kratom somehow

allowed them to taper off of those substances,

that they would look more favorably upon kratom

if and only if they would also commit to progressively

lowering their dose of kratom and eventually coming off

of kratom.

So the general takeaway from all of that is if you can avoid

taking kratom, meaning if you haven't taken it already,

don't.

And that reminds me of a very important point, which

a guest on the Huberman lab podcast Dr. Robert

Malenka who's an M.D. and Ph.D. He's

my colleague at Stanford School of Medicine.

He's a world expert on the mechanisms underlying addiction

and dopamine and drug reinforcement,

among many other things.

What he said on the podcast is absolutely true,

which is that it is impossible to get addicted to a substance

that you've never consumed.

That might seem obvious but think about that one again.

It is impossible to get addicted to a substance

that you've never consumed.

So I think the safest statement to make

is if you have not tried kratom, you

would be wise to avoid it because you

stand a chance to become addicted to it.

If, however, you are somebody that's

addicted to other forms of opioids,

you absolutely should talk to your physician about that

and how to get off of those opioids.

But there is evidence that some people have used kratom

to successfully wean themselves off the more potent forms

of opioids that I talked about, namely

morphine and hydrocodone, as well as a few others.

Now if you're somebody who already takes kratom,

you need to be very thoughtful about the dosage that you take.

And you also need to be thoughtful about the fact

that people differ dramatically in their response to opioids.

This is oh so important, and people do not

talk about this enough.

We hear, for instance, that, oh, if people are taking anywhere

from one to five grams, maybe one to six grams of kratom

per day, that's keeping it in the dosage

range for which people don't generally tend to get addicted,

you'll hear things like that.

And by the way, when I say one to five or one

to six grams per day, I'm not talking

about the individual compounds that are present in kratom.

There are a couple of different plant alkaloids

I'll talk about in a moment that are present in kratom.

And these have different effects on the opioid system.

So nowadays, some of the companies that sell kratom.

And by the way, this is sold over the counter

as a supplement.

It does not require a prescription

to purchase, at least at this point in time,

in the United States.

Some of these products will have a higher concentration of one

or the other alkaloids within them

such that you can't really compare

one gram of one brand of kratom to one gram of another brand

of kratom because they can have wildly different levels

of these different alkaloids.

And these different alkaloids have wildly different impact

on different aspects of your brain and body biology.

In particular, how much they tend to impact

the so-called endogenous opioid system, OK.

So when we talk about dosages, we

have to keep this in the back of our mind.

And we have to keep in the back of our mind

that there does seem to be a subgroup of people.

We don't know how big this subgroup of people is,

but we know it's not everyone, but it's somewhere between 10

and 40% of people seem to respond to opioids

in a particularly potent way.

They really like them.

And perhaps not surprisingly, people outside of that category

don't tend to like opioids.

I can certainly say that I am somebody

who, when I've been prescribed things like Vicodin

or any other opioid post-surgery for pain,

I hate taking those drugs.

I absolutely hate it.

I'd rather deal with the pain.

They make me nauseous.

They make me feel terrible.

That said, I know people who love opioids.

It's like a natural fit for their chemistry in the sense

that it tends to evoke more euphoria.

They just immediately like the feeling.

Some of you may remember the episode of the Huberman Lab

podcast that I did about alcohol.

And there, too, I discussed the fact that about 8% to 10%

of people who consume alcohol get an increased dopamine

response to alcohol that's not observed in other people.

And that particular subgroup of people is very, very at risk

for developing alcohol use disorder,

sometimes called alcoholism, because they can drink in a way

and they experience a high from drinking in a way

that other people simply do not experience.

Now like everybody else, if they consume too much alcohol,

they get drunk.

So it's not about the drunk effect,

it's about the dopamine and other sorts

of chemicals that are released in those people in response

to alcohol that other people just don't seem to experience

at the same level of potency.

So again, with things like kratom and the other opioids,

there's a category of people, and it's a much larger category

of people, again 10% to 40%.

We don't know exactly how many because the studies are not

really completed, and there aren't enough of those studies

yet, unfortunately.

But when those people take an opioid,

wow, oh, wow, do they like it.

And those people, in particular, are very much at risk

for developing an addiction to opioids.

And so those people, especially, should never ever go near

kratom if they haven't.

Or if they are already taking kratom,

these are the people that are constantly

ratcheting up their dose.

These are the people that tell you no, I'm not addicted,

but if you were to say, hey, all right,

well then let's do an experiment where you don't take kratom

for a week, those are going to be the people that are suddenly

going to get anxious about the mere idea of that.

I've also talked about this in reference

to cannabis when I did an episode about cannabis.

Again I'm not putting a blanket statement out

there about cannabis as being good or bad.

On that episode, I talked about the fact

that cannabis does indeed have various therapeutic uses.

But that there are a good number of people

who rely on cannabis for anxiety control

and other ways of modulating their brain chemistry

and bodily chemistry such that if you were to say,

hey, are you addicted to cannabis?

They'd say no, I don't have to smoke cannabis.

I don't have to take my edibles.

But if you were to push them a little bit and say,

all right, well then, let's do an experiment

where you don't consume any cannabis

in any form for 10 days.

They don't like the idea of that experiment at all.

So much so that were they to run that experiment,

they would experience a lot of the withdrawal symptoms

associated with addiction.

So I can't, in good faith, say that kratom

is safe for everybody because it is simply not.

Now is it safer than the other opioids?

And if so, why?

Well, in order to address that, let's

take a short glance at the pharmacology of kratom

and how it works in terms of its neurochemistry in the body.

Now I'm going to keep this pretty brief

because, in the future, I'm going

to do an extended episode all about opioids,

and I will include kratom in that conversation.

But just to back up a little bit and discuss what opioids are.

Opioids are compounds that can activate

the so-called endogenous opioid system.

All of us have within our brain and body

the capacity to release our own opioids.

That's right.

You have opioids within your body.

They are released from neurons, and they bind

to so-called opioid receptors.

Perhaps some of you have heard of the so-called runner's high.

The runner's high is a euphoric state.

It's a fairly mild euphoric state in most cases.

But it's a euphoric state induced

by long-duration effort, a.k.a.

the runner's high.

The runner's high is just a phrase

used to explain that when we engage

in long-duration repetitive action effort,

the body starts releasing these endogenous opioids they bind

to receptors, and they trigger things

like analgesia, relief from pain.

They trigger mild euphoria.

They tend to change our perception

of the outside world, make things

look more beautiful, shiny.

They give things a little bit of a sheen.

What I just described is a mild version

of what people experience when they

take something like morphine.

When people take morphine, there's

a more of a sedative effect, there's

more of a euphoric effect, and there's

more of a dreamlike effect.

And again, it will depend on dosage.

Kratom and morphine, and hydrocodone all

have the property of acting like the endogenous opioids

but at much higher potency.

When you bring them into your system,

they cross the blood-brain barrier.

So they go into the brain, and they

bind to a number of different opioid receptors.

There's the mu-opioid receptor.

By the way, these names all follow Greek alphabet letters.

So the mu-opioid receptor, the kappa opioid receptor,

there are a bunch of different ones.

Kratom binds preferentially to the mu-opioid receptor

and somewhat to the kappa opioid receptor.

There's a big misconception out there.

A lot of people, especially people

who are proponents of kratom, will

say no morphine and hydrocodone bind the mu-opioid receptor,

whereas kratom binds the kappa opioid receptor.

So it's a different compound.

Very, very different.

Not true.

Not true.

Kratom, morphine, and hydrocodone all bind

to the mu-opioid receptor.

And that's what's largely responsible

for its opioid-like effects.

Especially when you get the dosage up to a level

where you start getting the mild sedation, the analgesia,

the pain relief.

And keep in mind a lot of people are taking kratom

because they want pain relief.

And when that mu-opioid receptor system is activated,

it indirectly activates a lot of the reinforcement circuitry

in the brain that relates to dopamine and serotonin.

This is another area that we'll go into in more

depth in the future.

But there's been a lot of controversy.

People saying, oh, you know kratom

doesn't trigger the dopamine system,

therefore, it's not addictive.

But that is simply not true.

It indirectly activates the reinforcement circuitry

that includes both dopamine and serotonin.

But its primary effect is to hit this mu-opioid receptor

system that exists in a bunch of places in the brain

but mainly in the brainstem in a structure

called the periaqueductal gray nucleus, which

then provides pain relief.

It triggers a number of different shifts in cognition.

It's what creates that mild euphoria, et cetera, et cetera.

Now how can we be so confident that kratom is acting so

similarly to hydrocodone and to morphine,

albeit with lower potency?

And the reason is if you give people

a drug that blocks the mu-opioid receptor prior to them

taking kratom, they don't experience

any of the classic effects of taking kratom.

No euphoria, no analgesia, no sedation.

Even at the low dosages no mild stimulant effect.

So we really have to look at kratom as an opioid, OK.

That's just the honest truth.

And if you're somebody who doesn't like this message

because you like kratom, I'm not telling you

that you don't like kratom, I'm telling you likely like kratom

because it's an opioid.

So again, if you go online and you start asking questions

about kratom, again, you're going to see these two camps.

You're going to see the kratom is terrible,

it's addictive, it's everything bad camp.

And then you're going to see the other camp out there very vocal

as well, talking about how kratom helped them avoid

other things that are worse.

And this is an argument that, frankly, I

don't think we want to lean on, right.

The idea that substance A is not as bad as substance B.

And that making substance A unavailable

is just going to send everyone running for substance B. That's

a weak argument, frankly.

I heard this argument around cannabis.

And by the way, I think pretty balanced about cannabis.

If you listen to the episode I did on cannabis,

I think you'll agree that I believe that cannabis has

its therapeutic applications.

I also believe that young people, especially young males

with a predisposition to psychosis,

should not be taking high-concentration THC

cannabis.

Because the data tell us they are already

at risk of psychosis, and they are at a much greater risk

of psychosis if they do.

So I think I'm pretty balanced about the story on cannabis.

But I often hear the argument oh cannabis

isn't as bad as alcohol and, therefore, cannabis is good.

That's simply not rational.

What we should be saying is whether or not

it's cannabis or alcohol or kratom

or any substance for that matter, what

are the potential benefits, what are the potential risks?

And again, this is far too much than we

can go into in this AMA.

And we will go into in a future full-length episode

of the Huberman Lab podcast.

But the other thing to really keep in mind

is the lack of regulation over kratom supplements.

Now as many of you know, I am a fan

of many, not all, but many supplements

in certain conditions.

I always say behavior is first, then nutrition.

Then if and only if it's needed, rely on supplementation.

But supplementation is a big category.

But when we're talking about supplements

that are opioid compounds, I start

to get nervous because of the high abuse

potential and the high addiction potential of opioids.

And kratom is included in that category.

A couple of other key notes about kratom.

While death directly from kratom is fairly rare,

it has happened.

Now hydrocodone and morphine suppress respiration.

Actually, suppress breathing by way of a mechanism

that, if you're a listener of the Huberman Lab podcast,

you know about.

Which is the so-called physiological sigh.

Many of you have heard me talk about the physiological sigh.

Is something that you do voluntarily the double Inhale

through the nose and then a long exhale

in order to rapidly reduce your level of stress.

As far as we know, that's the fastest way

to deliberately lower your level of stress.

But the physiological sigh was discovered in the 1930s

as a spontaneous pattern of breathing

that occurs involuntarily in sleep in order

to reinflate the lungs and offload carbon dioxide

and bring oxygen back into the system

on the subsequent breath.

When I interviewed Dr. Jack Feldman, who

is a professor at University of California Los Angeles

and really the pioneer of the modern neuroscience

understanding of respiration, he talked about some studies

in his laboratory that were exploring why

people die when taking opioids.

This is a major issue associated with the opioid crisis.

And what he mentioned was that the opioids bind

to particular receptors in the brain

stem locations that generate physiological sighs.

So opioids, when taken as drugs, suppress physiological sighing

and do so during sleep.

And lack of adequate respiration,

meaning people stop breathing during sleep,

is one of the primary reasons why people

die when they take opioids.

Now kratom is not known to suppress respiration

when taken at low to moderate dosages.

But when combined with any other opioids,

and certainly when combined with alcohol,

it can suppress respiration.

And while the data on this are fairly scant,

there is some evidence that kratom-induced death

is caused by suppression of the respiration system.

So again, death due to taking kratom

at the dosages that are recommended

on most commercial packaging is fairly rare,

although it has happened.

It's unclear if it happened because it

was taken in combination with other compounds.

That seems likely.

But we can't forget that a lot of people

are taking kratom at much higher dosages and, in fact,

progressively higher and higher dosages

from these over-the-counter sources.

And with increased dosage, there is, yes, an increased risk

of respiratory failure.

So again, all of this points to the fact

that kratom is simply not a benign substance.

So if we're going to be very honest,

the addictive potential of kratom is real.

It is exacerbated for some people compared to others,

but it is real.

It's very similarities to other more potent forms of opioids

are what make it attractive for some people who

are trying to come off those more potent form of opioids.

But the goal, of course, is to completely come off

all opioids.

And kratom itself can be a bit of a trap.

It can be a trap in the sense that people

who have never taken other opioids

can become addicted to kratom itself.

That is absolutely clear that can happen.

It has happened in a great number of people.

It's also clear that kratom can potentially be a trap.

Notice I said potentially.

Because if people are trying to come off

other more potent forms of opioids

and then they use kratom to do that,

and then they're ratcheting up their dosage of kratom such

that they're now matching the endogenous response to kratom

in a way that doesn't really distinguish from the effects

that they were getting from morphine and hydrocodone,

well then they're just using a different form

of morphine and hydrocodone.

And I'm sure that some of you are out there

saying that is ridiculous.

You cannot compare the effects of kratom to the effects

of hydrocodone.

But the potency is about one-sixth of hydrocodone.

And there are people out there who

are just increasing and increasing both the dosage

and modifying the type of kratom that they're

taking so that they're getting the kratom that

has a particularly high concentration of one

of the alkaloids that hits that mu-opioid receptor hardest.

And in doing so, sure, they're not

getting the pure hydrocodone effect,

but they're getting really close.

So my advice would be, if you haven't touched kratom,

don't touch it at all, ever.

If you are taking kratom, you need

to take note of what we just discussed.

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