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INSUFFICIENT RELIABLE EVIDENCE to RATE

• Allergic rhinitis (hay fever). Although there has been interest in using oral betaine hydrochloride for allergic rhinitis, there is insufficient reliable information about the clinical use of betaine hydrochloride for this purpose.
• Asthma. Although there has been interest in using oral betaine hydrochloride for asthma, there is insufficient reliable information about the clinical use of betaine hydrochloride for this purpose.
• Atherosclerosis. Although there has been interest in using oral betaine hydrochloride for atherosclerosis, there is insufficient reliable information about the clinical use of betaine hydrochloride for this purpose.
• Diarrhea. Although there has been interest in using oral betaine hydrochloride for diarrhea, there is insufficient reliable information about the clinical use of betaine hydrochloride for this purpose.
• Dyspepsia. Although there has been interest in using oral betaine hydrochloride for indigestion caused by hypochlorhydria, there is insufficient reliable information about the clinical use of betaine hydrochloride for this purpose.
• Food allergies. Although there has been interest in using oral betaine hydrochloride for food allergies, there is insufficient reliable information about the clinical use of betaine hydrochloride for this purpose.
• Gallbladder disease. Although there has been interest in using oral betaine hydrochloride for gallbladder disease, there is insufficient reliable information about the clinical use of betaine hydrochloride for this purpose.
• Hyperhomocysteinemia. Although there has been interest in using oral betaine hydrochloride for hyperhomocysteinemia, there is insufficient reliable information about the clinical use of betaine hydrochloride for this purpose.
• Hypothyroidism. Although there has been interest in using oral betaine hydrochloride for hypothyroidism, there is insufficient reliable information about the clinical use of betaine hydrochloride for this purpose.
• Rheumatoid arthritis (RA). Although there has been interest in using oral betaine hydrochloride for RA, there is insufficient reliable information about the clinical use of betaine hydrochloride for this purpose. More evidence is needed to rate betaine hydrochloride for these uses.

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INSUFFICIENT RELIABLE EVIDENCE to RATE

• Aging. Although there has been interest in using oral kombucha for aging, there is insufficient reliable information about the clinical effects of kombucha for this purpose.
• Diabetes. Although there has been interest in using oral kombucha for diabetes, there is insufficient reliable information about the clinical effects of kombucha for this purpose.
• Memory. Although there has been interest in using oral kombucha to improve memory, there is insufficient reliable information about the clinical effects of kombucha for this purpose.
• Obesity. Although there has been interest in using oral kombucha for weight loss, there is insufficient reliable information about the clinical effects of kombucha for this purpose. More evidence is needed to rate kombucha for these uses.

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INSUFFICIENT RELIABLE EVIDENCE to RATE

• Cardiovascular disease (CVD). Although there has been interest in using oral wasabi to prevent CVD, there is insufficient reliable information about the clinical effects of wasabi for this purpose.
• Chronic fatigue syndrome (CFS). It is unclear if oral wasabi is beneficial for myalgic encephalomyelitis/chronic fatigue syndrome. Details: A very small open-label clinical study in adults with myalgic encephalomyelitis/chronic fatigue syndrome shows that taking a wasabi extract containing 3.2 mg of the 6-(methylsulfinyl) hexyl isothiocyanate constituent 3 times a day for 12 weeks modestly improves some scores related to fatigue and the frequency of myalgia and headache when compared to baseline (112845). However, the validity of this study is limited by the lack of a comparator group.
• Dyspepsia. Although there has been interest in using oral wasabi for dyspepsia, there is insufficient reliable information about the clinical effects of wasabi for this purpose.
• Fatigue. It is unclear if oral wasabi is beneficial for fatigue. Details: A small open-label clinical study in healthy adults experiencing fatigue shows that taking wasabi extract 600 mg (containing 4.8 mg of 6-(methylsulfinyl) hexyl isothiocyanate, a constituent of wasabi) daily for 4 weeks improves self-reported scores of fatigue and some factors related to mood when compared to baseline. Oral wasabi extract also improves self-reported scores regarding sleep (e.g., quality of sleep, sleepiness after rising) (112846). However, the validity of these findings is limited by the lack of a comparator group.
• Irritable bowel syndrome (IBS). Although there has been interest in using oral wasabi for IBS, there is insufficient reliable information about the clinical effects of wasabi for this purpose.
• Osteoporosis. Although there has been interest in using oral wasabi for osteoporosis, there is insufficient reliable information about the clinical effects of wasabi for this purpose. More evidence is needed to rate wasabi for these uses.

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POSSIBLY SAFE ...when taken orally as a single dose of up to 1500 mg (93328,93329). There is insufficient reliable information available about the safety of betaine hydrochloride when used in multiple doses.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about BETAINE HYDROCHLORIDE)

POSSIBLY SAFE ...when consumed orally after being properly and hygienically prepared (2650,2651,2652,2653).

POSSIBLY UNSAFE ...when non-sterile home preparations are consumed orally. These preparations are at risk for contamination with opportunistic pathogens (2650,2651,2652,2653).

LIKELY UNSAFE ...when consumed orally after being prepared or stored in a container with toxic constituents, such as lead glaze (1366,2655). Lead poisoning was reported in two people who consumed kombucha prepared in a lead-glazed ceramic pot for six months (1366).

PREGNANCY AND LACTATION: POSSIBLY UNSAFE
when used orally; avoid using.

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LIKELY SAFE ...when used orally in food amounts (29994). When used orally and appropriately in medicinal amounts, short-term, wasabi extract 600 mg once daily has been safely used for up to 4 weeks (112846).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

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ANTACIDS Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Betaine hydrochloride increases stomach acidity and could decrease the effects of antacids.  Details In human research, betaine hydrochloride increases stomach acidity (93328,93329). Antacids are taken to decrease stomach acidity. Theoretically, taking betaine hydrochloride along with antacids might decrease the effects of the antacids.

H2-BLOCKERS Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Betaine hydrochloride increases stomach acidity and could decrease the effects of H2-blockers.  Details In human research, betaine hydrochloride increases stomach acidity (93328,93329). H2-blockers are used to decrease stomach acidity. Theoretically, taking betaine hydrochloride along with H2-blockers might decrease the effects of H2-blockers.

PROTON PUMP INHIBITORS (PPIs) Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Betaine hydrochloride increases stomach acidity and could decrease the effects of PPIs.  Details In human research, betaine hydrochloride increases stomach acidity (93328,93329). PPIs are used to decrease stomach acidity. Theoretically, taking betaine hydrochloride along with PPIs might decrease the effects of PPIs

(Read more about BETAINE HYDROCHLORIDE)

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, kombucha might increase the risk of hypoglycemia when taken with antidiabetes drugs.  Details Animal research shows that administering kombucha can lower blood glucose levels (57756,109596).

DISULFIRAM (Antabuse) Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, kombucha might cause a disulfiram reaction when taken with disulfiram.  Details Kombucha products can contain up to 3.6% alcohol (2650,103179,109594).

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ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, wasabi might increase the risk of bleeding with anticoagulant or antiplatelet drugs.  Details In vitro research shows that 6-(methylsulfinyl) hexyl isothiocyanate, a constituent of wasabi, inhibits platelet aggregation (29143).

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General ...Orally, betaine hydrochloride is generally well tolerated when taken as a single dose.

Gastrointestinal ...Theoretically, the hydrochloric acid produced from betaine hydrochloride might irritate gastric or duodenal ulcers or impede ulcer healing. It might also cause heartburn.

(Read more about BETAINE HYDROCHLORIDE)

General ...Orally, kombucha seems to be well tolerated. However, kombucha that is prepared in non-sterile environments or stored in containers made with toxic constituents might be unsafe.
Most Common Adverse Effects:
Orally: Gastrointestinal complaints, including nausea and vomiting.
Serious Adverse Effects (Rare):
Orally: Cardiac arrest and death.

Cardiovascular ...Two cases of cardiac arrest, one resulting in death, possibly associated with kombucha consumption have been reported (2655,57764).

Dermatologic ...In one case report, topical application of kombucha was associated with cutaneous anthrax infection. However, the kombucha could have been contaminated due to unhygienic preparation conditions (2651,57733,57767).

Endocrine ...In one case, a 22 year-old male with HIV presented with hyperthermia, lactic acidosis, and acute renal failure 15 hours after ingesting kombucha (57748).

Gastrointestinal ...Orally, use of kombucha has been associated with reports of stomach problems, nausea, and vomiting (2652,2656,57733,57742). The acidic content of kombucha increases with the duration of fermentation during preparation, which may contribute to development of stomach ulcers (103179).

Hepatic ...Two cases of hepatotoxicity likely related to contaminated kombucha consumption for a month or more have been reported (57761,57733,94519).

Musculoskeletal ...Head and neck pain associated with consumption of kombucha was described in a single patient (2656,57733). In one case, a male developed anti-Jo1 antibody-positive myositis after drinking kombucha (57737).

Neurologic/CNS ...Dizziness associated with consumption of kombucha, possibly due to its alcohol content, has been reported (57733,57762).

Renal ...In one case, a 22 year-old male with HIV presented with hyperthermia, lactic acidosis, and acute renal failure 15 hours after ingesting kombucha (57748).

Other ...Due to the acidic nature of kombucha, toxic elements present in storage containers may leach into the product (2655). In one report, symptomatic lead poisoning requiring chelation decontamination therapy occurred in two people who consumed kombucha prepared in a lead-glazed ceramic pot for six months (1366).

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General ...Orally, wasabi seems to be well tolerated in medicinal amounts.

Endocrine ...A small clinical study in adults taking oral wasabi extract 2000 mg once daily for 4 weeks has found 1 case of ketone bodies in the urine (112846).

Hepatic ...A small clinical study in adults taking oral wasabi extract 1000 mg once daily for 4 weeks has found 1 case of mildly elevated alanine transaminase and aspartate transaminase levels (112846).

Musculoskeletal ...A small clinical study in adults taking oral wasabi extract 2000 mg once daily for 4 weeks has found 1 case of elevated creatine phosphokinase (112846).

Renal ...A small clinical study in adults taking oral wasabi extract 1000 mg once daily for 4 weeks has found 2 cases of proteinuria (112846).

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