Hemp Force Vanilla-Acai Flavor by Onnit Labs

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Aging skin. Although there is interest in using oral or topical acai to prevent aging skin, there is insufficient reliable information about the clinical effects of acai for this purpose.
• Athletic performance. It is unclear if oral acai is beneficial for improving athletic performance. Details: Preliminary clinical research in amateur cyclists shows that consuming 400 grams of pasteurized acai pulp daily for 15 days prevents oxidative damage and decreases levels of blood lactate during exercise by 28% when compared with placebo. Consuming acai pulp also seems to increase anaerobic threshold intensity, but does not improve maximum workload or measures of exertion, when compared to baseline (102860).
• Erectile dysfunction (ED). Although there is interest in using oral acai for ED, there is insufficient reliable information about the clinical effects of acai for this condition.
• Hypercholesterolemia. Although there is interest in using oral acai for hypercholesterolemia, there is insufficient reliable information about the clinical effects of acai for this condition.
• Metabolic syndrome. Although there is interest in using oral acai for metabolic syndrome, there is insufficient reliable information about the clinical effects of acai for this condition.
• Obesity. It is unclear if oral black seed is beneficial for improving metabolic indices in overweight individuals. Details: In overweight individuals, preliminary clinical research shows that consuming 100 mg of acai pulp (Sambazon Acai Smoothie Pack, Sambazon Inc.) twice daily for one month reduces fasting glucose and total cholesterol levels when compared with baseline. However, no effect was seen on levels of low density lipoprotein (LDL) cholesterol, triglycerides, high density lipoprotein (HDL) cholesterol, or blood pressure (17731). The validity of these findings is limited by the lack of a comparator group.
• Osteoarthritis. Although there is interest in using oral acai for osteoarthritis, there is insufficient reliable information about the clinical effects of acai for this condition.
• Tinnitus. It is unclear if oral acai is beneficial for chronic tinnitus. Details: A small clinical study in adults with unilateral or bilateral chronic tinnitus, with either normal hearing or mild hearing loss, shows that taking dried acai pulp extract 100 mg daily for 3 months decreases tinnitus discomfort when compared with baseline (107846). However, the validity of this finding is limited by the lack of statistical comparison to the placebo group, which reported a numerically similar improvement in tinnitus discomfort. More evidence is needed to rate acai for these uses.

(Read more about ACAI)

POSSIBLY INEFFECTIVE

• Hyperlipidemia. A meta-analysis of small clinical studies suggests that consuming chia seeds, flour, powder, or oil for 7-24 weeks does not improve lipid levels in patients with conditions associated with hyperlipidemia. Details: A meta-analysis of 10 small clinical trials in patients with various metabolic conditions, including diabetes, metabolic syndrome, nonalcoholic fatty liver disease, and obesity, shows that consuming chia seeds, flour, or powder 15-60 grams daily for 7-24 weeks, or taking chia oil 6 grams daily for 8 weeks, does not reduce total cholesterol, low-density lipoprotein (LDL) cholesterol, or triglyceride levels or increase high-density lipoprotein (HDL) cholesterol levels when compared with control groups consuming wheat bran, oat bran, dietary fiber, poppy seeds, or soybean oil (106657). While the patient populations in the studies analyzed are more likely to develop hyperlipidemia, it is unclear if these findings can be generalized to patients diagnosed with hyperlipidemia.
• Obesity. Small clinical studies suggest that consuming chia seeds for up to 12 weeks does not reduce body weight in overweight or obese adults. Details: One small clinical study in overweight or obese individuals shows that ingesting chia seeds 25 grams mixed in 0.25 liters of water twice daily before meals for 12 weeks does not improve body composition or reduce blood pressure when compared with placebo (25533). Another small clinical study in overweight, postmenopausal females shows that ingesting milled or whole chia seeds 25 grams daily for 10 weeks does not improve body composition or blood pressure when compared to baseline (25532).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Athletic performance. It is unclear if oral chia is beneficial for improving athletic performance. Details: A small clinical study in trained athletes shows that drinking a beverage containing 50% of calories from chia seeds (Greens Plus Omega 3 Chia seeds) and 50% of calories from a carbohydrate-containing beverage (Gatorade) for 2 days prior to participating in an endurance exercise lasting more than 90 minutes leads to similar performance when compared with Gatorade alone (25531).
• Cardiovascular disease (CVD). Although there has been interest in using oral chia for CVD, there is insufficient reliable information about the clinical effects of chia for this purpose.
• Diabetes. Small clinical studies suggest that consuming chia for 4-6 months might reduce systolic blood pressure (SBP) in patients with type 2 diabetes, although it does not appear to improve glycemic control or lipid levels and has shown mixed effects on body weight and inflammatory markers. Details: One small clinical trial in patients with type 2 diabetes shows that consuming bread containing a specific, selectively bred type of chia (Salba, Salba Smart Natural Products LLC), providing 37 grams of chia daily for 12 weeks reduces SBP, C-reactive protein, and vonWillebrand factor, but not lipid levels, when compared with consuming bread containing wheat bran. This form of chia also significantly reduced glycated hemoglobin (HbA1c) when compared to baseline, but not when compared with a wheat bran control (16124). Another small clinical study in adults with type 2 diabetes and obesity shows that consuming Salba chia 40 grams daily, either baked into bread or as a powder, in conjunction with a restricted calorie diet for 6 months reduces weight by 1.6 kg and waist circumference by 2.8 cm when compared with an oat bran control. However, consuming chia had no effect on body fat percentage, HbA1c, or fasting glucose levels (97940). Also, a small clinical study in adults with type 2 diabetes shows that consuming chia seeds 40 grams daily for 12 weeks reduces SBP, but does not improve body weight, HbA1c, or levels of fasting glucose, lipids, or C-reactive protein, when compared with those not consuming chia (106658).
• Hypertension. It is unclear if oral chia is beneficial in patients with hypertension. Details: A very small clinical study in patients with mild hypertension shows that consuming chia flour 35 grams daily for 12 weeks reduces systolic blood pressure (SBP) by around 10 mm Hg and diastolic blood pressure (DBP) by almost 9 mm Hg when compared to baseline. In patients already taking antihypertensive drugs, chia seems to have an even greater impact on SBP and DBP. However, in patients not being treated with antihypertensive drugs, chia flour modestly reduces SBP by 6.5%, but does not significantly reduce DBP. No improvements in blood pressure were reported in patients consuming a wheat bran control (91516).
• Nonalcoholic fatty liver disease (NAFLD). It is unclear if oral chia is beneficial in patients with NAFLD. Details: Small, uncontrolled clinical studies in patients with NAFLD show that consuming milled chia seeds 25 grams daily for 8 weeks may reduce hepatic steatosis, as measured by the liver: spleen attenuation ratio, in up to 43% of subjects with prediabetes and 100% of subjects with diabetes when compared to baseline. Chia seed supplementation may also modestly reduce visceral fat, body mass index, and waist circumference in patients with prediabetes when compared to baseline, but does not seem to improve lipid levels (104530,110438). The validity of these findings is limited by the lack of a comparator group in both studies.
• Metabolic syndrome. Oral chia has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in patients with metabolic syndrome shows that reducing daily caloric intake by 500 kcal and drinking a beverage containing chia seed 4 grams, soy protein 32 grams, dehydrated nopal 7 grams, and oat 22 grams daily for 2 months reduces body weight, body mass index, and waist circumference when compared to baseline, but not when compared with following a reduced calorie diet alone. However, following the reduced calorie diet and drinking this beverage appears to lower serum triglycerides and C-reactive protein and improve glucose tolerance when compared with a reduced calorie diet alone (25534). It is unclear if these findings are due to chia, other ingredients, or the combination.
• Muscle strength. It is unclear if oral chia is beneficial for increasing muscle strength and muscle mass during resistance training. Details: A very small clinical trial in healthy, non-resistance trained males shows that drinking a supplemental beverage containing chia flour 50 grams, providing 20 grams of protein and 3 grams of omega-3 fatty acids, is no more effective than whey protein 20 grams or placebo for augmenting the increases in muscle strength and fat-free mass that occur with an 8-week whole body resistance training program (112385). The habitual baseline diet of the study participants already contained dietary protein intakes recommended for strength training, and the beverage was only consumed three times per week immediately after training sessions.
• Pruritus. It is unclear if topical chia seed oil is beneficial in patients with pruritus. Details: One very small, uncontrolled clinical study in patients with xerotic pruritus or pruritus caused by kidney failure or diabetes shows that applying lotion containing chia seed oil 4% for 8 weeks improves skin hydration and reduces the severity of lichen simplex chronicus and prurigo nodularis when compared to baseline (25537). The validity of these findings is limited by the small study size and lack of a comparator group. More evidence is needed to rate chia for these uses.

(Read more about CHIA)

POSSIBLY INEFFECTIVE

• Bipolar disorder. Oral flaxseed oil does not seem to reduce symptoms of bipolar disorder in children. Details: Clinical research in children ages 6-17 years with bipolar disorder shows that taking flaxseed oil, titrated to provide up to 6.5 grams of the flaxseed oil constituent alpha-linolenic acid, daily for 16 weeks does not improve symptoms of mania or depression when compared with placebo (66044).
• Hyperlipidemia. Oral flaxseed oil does not seem to reduce cholesterol levels. Details: Although some evidence from preliminary, low-quality clinical studies disagrees (21698,26466,76696), most clinical research shows that taking flaxseed oil does not reduce cholesterol or triglyceride levels in patients with or without hypercholesterolemia or hypertriglyceridemia (2317,16791,16794,21693,21694,21696,21697,22177,72228,101947)(101954,101956,111062). A meta-analysis of clinical studies evaluating various flaxseed formulations suggests that flaxseed oil consumption may reduce apolipoprotein A levels, but not apolipoprotein B levels, when compared with control groups (108046). A subgroup analysis from another meta-analysis suggests that flaxseed oil may modestly improve levels of high-density lipoprotein cholesterol (108044). It should be noted that most research suggests that flaxseed, the source of flaxseed oil, can improve lipid levels in adults with hyperlipidemia. This difference may be due to lipid lowering components such as lignans, phytic acid, and polyphenols, that are found in flaxseed, but not flaxseed oil. See the Flaxseed monograph for more information.
• Obesity. Oral flaxseed oil does not seem to improve weight loss. Details: A meta-analysis of clinical research in overweight adults shows that flaxseed oil consumption does not reduce body weight, body mass index, or waist circumference when compared with control (96427). This is in contrast to research suggesting that flaxseed, the source of flaxseed oil, can improve weight loss in obese and overweight adults. See the Flaxseed monograph for more information.
• Rheumatoid arthritis (RA). Oral flaxseed oil does not seem to improve symptoms of RA. Details: A small clinical study in patients with RA shows that taking flaxseed oil daily for 3 months does not seem to improve symptoms of pain and stiffness, and has no effect on laboratory measures of RA, such as C-reactive protein and erythrocyte sedimentation rate (ESR), when compared with control (5898).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Atherosclerosis. Small clinical trials show that taking flaxseed oil has modest benefit on metabolic risk factors in patients with plaque in the coronary artery. Details: Observational research in White adults has found that high dietary intake of linolenic acid, a flaxseed oil constituent, is associated with reduced calcified atherosclerotic plaque in the coronary arteries (12990). However, clinical research has not confirmed this finding. A small clinical trial in patients with coronary artery disease shows that taking flaxseed oil 5 grams in milk containing 1.5% fat reduces triglyceride levels by 14% when compared with the milk alone. However, there was no effect on systolic blood pressure, high-density lipoprotein (HDL) cholesterol, or low-density lipoprotein (LDL) cholesterol (101954). Additionally, another small study in a similar patient population shows that taking flaxseed oil 2 grams daily for 12 weeks has no effect on lipid levels when compared with placebo (101956).
• Attention deficit-hyperactivity disorder (ADHD). Oral flaxseed oil has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical trial in children with ADHD shows that taking flaxseed oil, providing 200 mg of alpha-linolenic acid, in combination with vitamin C 25 mg, twice daily can improve measures of attention, impulsivity, restlessness, and self-control when compared to baseline (14443). This finding is limited by the lack of a control group. Furthermore, it is unclear if the benefit is due to flaxseed oil, vitamin C, or the combination.
• Breast cancer. It is unclear if oral flaxseed oil reduces the risk of breast cancer. Details: Population research has found that females with higher levels of the flaxseed oil constituent, alpha-linolenic acid (ALA), in breast adipose tissue have a lower risk of breast cancer. Fatty acid composition of adipose tissue is thought to reflect past dietary intake, so researchers think high intake of ALA might have a cancer protective effect (7168,21689). Flaxseed oil is one source of ALA; it is unclear what effect, if any, flaxseed oil has on breast cancer risk.
• Burns. It is unclear if oral flaxseed oil improves wound healing and health in people with burns. Details: A small clinical trial in patients with mild to moderate burns shows that eating cookies containing flaxseed oil 30 grams and isolated soy protein (ISP) 50 grams daily for 3 weeks improves the rate of wound healing when compared with control cookies. It seems to take at least 3 weeks before this difference is observed. However, there is no significant difference in the rate of wound healing when compared with cookies containing ISP with corn oil (99401). It is possible that the study was underpowered to detect a difference between these two groups.
• Cardiovascular disease (CVD). It is unclear if oral flaxseed oil reduces the risk of CVD. Details: Flaxseed oil is a source of alpha-linolenic acid (ALA). A meta-analysis of observational studies has found that, overall, increasing dietary intake of ALA by 1.2 grams daily is associated with a 20% reduced risk of fatal coronary heart disease in people with existing heart disease (12978). Some research suggests that ALA has a greater impact on coronary heart disease when intake of fish oils is low (12989). It is unknown if flaxseed oil supplements have these same effects. Additionally, it is difficult to separate effects of dietary ALA in these studies from those of other dietary, lifestyle, or drug interventions (12917).
• Carpal tunnel syndrome. It is unclear if topical flaxseed oil reduces carpal tunnel pain. Details: Preliminary clinical research in patients with carpal tunnel syndrome who wear a wrist splint at night shows that applying flaxseed oil 5 drops topically on the palmar wrist twice daily for 4 weeks improves subjective symptom scores by 30%, function scores by 17%, and sensory nerve conduction velocity of the median nerve by about 7% when compared to baseline. Compared to the changes observed for patients in the placebo group, these improvements were significant (25691). It is unclear if this benefit persists long-term or how topical flaxseed oil compares to other standard treatments for carpal tunnel syndrome.
• Chronic kidney disease (CKD). Although there is interest in using oral flaxseed oil for CKD, there is insufficient reliable information about the clinical effects of flaxseed for this condition.
• Cognitive function. It is unclear if oral flaxseed oil improves cognitive function in healthy adults. Details: Clinical research in healthy older Japanese adults with normal cognitive function shows that taking flaxseed oil 3.7 grams daily for 12 weeks modestly improves verbal fluency when compared with taking placebo. However, there was no effect on other measures of cognitive function, including attention, concentration, and memory (111060).
• Diabetes. Oral flaxseed oil may not improve glycemic control in patients with type 2 diabetes. However, there may be some benefit in patients with gestational diabetes. Details: Most clinical research in patients with type 2 diabetes shows that taking flaxseed oil, providing about 1-16 grams of alpha-linolenic acid, daily for up to 6 months does not improve fasting blood glucose, glycated hemoglobin (HbA1C), or insulin resistance when compared with placebo (16792,66065,96428,96431,101956,111062). While taking flaxseed oil does not seem to be beneficial for type 2 diabetes, it might improve outcomes in gestational diabetes. A small clinical study in pregnant patients (24-28 weeks gestation) with gestational diabetes shows that taking flaxseed oil 1 gram twice daily for 6 weeks reduces fasting levels of glucose and insulin and improves insulin resistance when compared with placebo (101957). Another small clinical study in patients with gestational diabetes shows that taking flaxseed oil 1 gram, containing 400 mg of alpha-linolenic acid, along with vitamin E 400 IU daily for 6 weeks reduces blood glucose levels, insulin levels, and insulin resistance and improves beta-cell function when compared with placebo (96432). It is unclear if the findings from this latter study are due to flaxseed oil, vitamin E, or the combination.
• Diabetic foot ulcers. It is unclear if oral flaxseed oil improves the healing of diabetic foot ulcers. Details: One small clinical trial in adults with grade 3 diabetic foot ulcers shows that taking flaxseed oil 1 gram twice daily for 12 weeks in conjunction with intravenous antibiotics for the first 3 weeks reduces ulcer size when compared with placebo (96431).
• Dry eye. Flaxseed oil, both orally and as an eye drop, has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One small clinical study in patients with dry eye shows that taking a specific combination product (TheraTears Nutrition, Advanced Vision Research) containing eicosapentaenoic acid 450 mg, docosahexaenoic acid 300 mg, and flaxseed oil 1000 mg daily for 90 days reduces subjective symptoms of dry eye and might increase tear production when compared with placebo. However, it did not improve meibomian gland secretions or tear evaporation rate when compared with placebo (17523). Eye drops with flaxseed oil have also been tried for dry eye. A clinical study shows that using a specific product (Refresh Optive MEGA-3 Preservative-Free Lubricant Eye Drops, Allergan plc) which contains flaxseed oil and trehalose in addition to other ingredients such as carboxymethylcellulose (CMC) and castor oil twice daily for 90 days improves dry eye symptoms when compared to baseline, but not when compared with the same eye drops formulated without flaxseed oil and trehalose (101953).
• Dry skin. There is conflicting evidence regarding the use of flaxseed oil for dry skin. Details: Some clinical research suggests that taking flaxseed oil 2.2 grams orally in combination with alpha-tocopherol 10 mg daily for 12 weeks does not improve skin hydration when compared with placebo or borage oil in females with dry skin, although the combination seems to improve the sensitivity of dry skin (21908). Other clinical research suggests that taking flaxseed oil 2.2 grams daily for 12 weeks improves skin hydration and roughness when compared with safflower oil (21909).
• Endometrial hyperplasia. It is unclear if oral flaxseed oil reduces endometrial hyperplasia. Details: A small clinical trial in adults with endometrial hyperplasia shows that taking flaxseed oil 1 gram twice daily for 12 weeks does not induce endometrial regression or reduce cholesterol levels when compared with placebo. However, there appears to be a small benefit on fasting plasma glucose and insulin levels (101955).
• Hypertension. Small studies suggest that flaxseed oil may modestly lower blood pressure in some patients. Details: Epidemiological research has found that high dietary intake of linolenic acid, a flaxseed oil constituent, is associated with a reduced risk of developing hypertension (12991). Meta-analyses of small clinical studies in patients with and without hypertension show that receiving flaxseed oil 1.2-30 grams daily for 4-24 weeks reduces systolic and diastolic blood pressure by 0.5 mmHg to 4 mmHg, when compared with control (96426,111063). One meta-analysis limited to small clinical trials in patients with metabolic syndrome, hypercholesterolemia, or hypertension, shows that taking flaxseed oil 25 mL or 2.2 to 9.2 grams daily for 7-12 weeks reduces systolic blood pressure by about 3.9 mmHg; however, there is no effect on diastolic blood pressure (111067). The small size and heterogeneity of the studies included in these meta-analysis limit the validity of these findings. Also, the effect of taking flaxseed oil in patients specifically with hypertension is unclear from this available research. Flaxseed oil has also been evaluated in combination with other oils and dietary interventions, with mixed evidence of benefit. Flaxseed oil 19 grams, providing 10.5 grams of alpha-linolenic acid, seems to reduce blood pressure when combined with walnuts and walnut oil daily for 6 weeks (21905). However, consuming 60 grams of a combination of flaxseed and safflower oils in a 6:4 ratio daily for 4 weeks does not seem to affect blood pressure when compared with baseline (26466).
• Mastalgia. It is unclear if oral flaxseed oil is beneficial in patients with mastalgia. Details: A clinical study in adults with fibrocystic breasts and mastalgia shows that taking flaxseed oil 1000 mg containing 350 mg alpha-linolenic acid twice daily for 2 months reduces pain when compared with baseline, but is no different than taking vitamin E 200 IU daily (105477).
• Metabolic syndrome. It is unclear if oral flaxseed oil is beneficial in patients with metabolic syndrome. Details: A small clinical study in patients with metabolic syndrome shows that taking flaxseed oil 20 mL daily for 7 weeks does not improve coagulation scores based on prothrombin time, partial thromboplastin time, and the international normalized ratio (INR) when compared with sunflower oil (101951).
• Nonalcoholic fatty liver disease (NAFLD). It is unclear if oral flaxseed oil is beneficial in patients with NAFLD. Details: Clinical research in overweight or obese patients with NAFLD shows that taking flaxseed oil 20 grams daily for 12 weeks as part of a hypocaloric diet improves the grade of fatty liver by 41%, compared with 18% in patients taking sunflower oil. There was also a small effect on body mass index, although there was no effect on liver enzymes, glycemic control, or body composition (101952).
• Parkinson disease. Oral flaxseed oil has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One small clinical study in patients with Parkinson disease shows that taking flaxseed oil 1 gram daily plus vitamin E 400 IU daily for 12 weeks improves the Unified Parkinson Disease Rating Scale (UPDRS) total score by 3.3 points, compared to a 4.4-point worsening in the placebo group (96430). However, it is unclear if this change is clinically meaningful. The minimal clinically important improvement in UPDRS total score is 4.3 points, while a moderate improvement ranges from 9 to 17 points (95686). Also, it is not clear if these findings are due to flaxseed oil, vitamin E, or the combination.
• Physical performance. It is unclear if oral flaxseed oil improves physical performance in older adults. Details: A small clinical study in elderly adults without previous exercise training suggests that flaxseed oil containing alpha-linolenic acid does not improve muscle strength when compared with placebo (65937).
• Pneumonia. It is unclear if oral flaxseed oil helps to prevent pneumonia. Details: Epidemiological research has found that increasing dietary alpha-linolenic acid, which occurs in flaxseed oil, is associated with a reduced risk of community-acquired pneumonia (13760). However, this research did not specifically assess the effect of flaxseed oil intake on pneumonia.
• Polycystic ovary syndrome (PCOS). Small clinical studies suggest that oral flaxseed oil might help to improve some markers of PCOS. Details: A small clinical study in patients with PCOS shows that taking flaxseed oil, providing 545 mg of alpha-linolenic acid, for 6 weeks lowers triglycerides but does not affect weight, hormone levels, glycemic control, or cholesterol levels when compared to baseline (21906). This finding is limited by the lack of a control group. Another small clinical study in patients with PCOS shows that taking flaxseed oil, providing 1 gram of omega-3 fatty acids, twice daily in addition to metformin for 12 weeks decreases triglyceride and insulin levels, but does not affect fasting blood glucose, testosterone levels, free androgen index, or total cholesterol when compared with placebo (99402).
• Prostate cancer. Oral flaxseed oil does not seem to be linked to prostate cancer risk. Details: Although some epidemiologic research has found that high dietary intake of alpha-linolenic acid, a constituent of flaxseed oil, is associated with an increased risk for prostate cancer (1334,1337,2558,7823,7147,12978,12961), other research has found no association (12961,15736). Furthermore, it appears that alpha-linolenic acid from plant sources, such as flaxseed or flaxseed oil, does not increase prostate cancer risk (12909).
• Ulcerative colitis. It is unclear if oral flaxseed oil is beneficial in patients with ulcerative colitis. Details: A small open-label clinical study in patients with ulcerative colitis shows that taking flaxseed oil 10 grams daily for 12 weeks seems to modestly reduce inflammatory markers and disease severity and improve quality of life when compared with control (101941). More evidence is needed to rate flaxseed oil for these uses.

(Read more about FLAXSEED OIL)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Atopic dermatitis (eczema). It is unclear if oral hemp seed oil is beneficial in patients with eczema. Details: A small preliminary clinical trial in patients with eczema shows that taking hemp seed oil 30 mL daily for 8 weeks improves skin dryness, itchiness, and use of dermal medication when compared with baseline, but not when compared with an olive oil control (101125).
• Constipation. Oral hemp seed has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research in patients with functional constipation shows that taking a proprietary Chinese herbal medicine (Hemp Seed Pill) containing hemp seed, rhubarb root, peony root, apricot kernel, bitter orange fruit, and magnolia bark twice daily for 8 weeks results in a response rate to 43%, compared with 8% in those taking placebo. The response rate was defined as an increase of at least 1 complete spontaneous bowel movement per week. This combination product also improved the responder rate in the 2 weeks after treatment, as well as the overall use of rescue therapy, when compared with placebo (101127). Data from this study pooled with data from another larger study in adults with functional constipation shows that this same product increases the likelihood of complete response, defined as at least 3 complete spontaneous bowel movements per week or an increase over baseline of at least 1 weekly, by 1.43 times when compared with placebo. Complete spontaneous bowel movements per week also increased by 1 when compared with placebo (107319). It is unclear if these effects are due to hemp seed, other ingredients, or the combination.
• Dysmenorrhea. Although there is interest in using oral hemp for dysmenorrhea, there is insufficient reliable information about the clinical effects of oral hemp for this condition.
• Familial hypercholesterolemia. It is unclear if oral hemp seed oil is beneficial in children with this condition. Details: A small preliminary clinical trial shows that taking hemp seed oil (AlfaLife, Freia Farmaceutici Srl) 3 grams daily for 8 weeks does not improve levels of total or low-density lipoprotein (LDL) cholesterol when compared with no treatment in hyperlipidemic children aged 6-16 years who are also following a low-fat diet with high fruit and vegetable intake (101144).
• Joint pain. Although there is interest in using oral hemp for joint pain, there is insufficient reliable information about the clinical effects of oral hemp for this condition.
• Multiple sclerosis (MS). Oral hemp seed has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in patients with relapsing-remitting MS shows that taking a combination of hemp seed oil 5.4-6.3 grams and evening primrose oil three times daily for 6 months seems to improve disability scores and relapse rate when compared to baseline. However, the control group in this study ingested olive oil and also experienced notable improvements in disability and relapse rates (88183). This study is limited due to high dropout rate and because there was no statistical comparison between treatment and control groups.
• Obesity. It is unclear if an oral cannabidiol-rich hemp oil extract helps to improve weight loss. Details: A small clinical study in healthy overweight adults shows that taking a specific hemp oil extract (PlusCBD Extra Strength Hemp Extract, CV Sciences) as 60 mg, providing 15 mg cannabidiol, daily for 6 weeks, does not reduce weight or body mass index when compared with placebo (103805). The validity of this study is limited due to its exploratory nature and lack of control for voluntary dietary changes.
• Osteoarthritis. It is unclear if oral hemp seed is beneficial in patients with osteoarthritis. Details: A clinical study in 18 older adults with osteoarthritis undergoing in-hospital rehabilitation following knee or hip arthroplasty shows that consuming pasta enriched with hemp seed flour for 6 weeks improves pain scores by about 3 points, compared with only 1 point in those consuming a regular pasta control (107320).
• Psychological well-being. Although there is interest in using oral hemp for psychological well-being, there is insufficient reliable information about the clinical effects of oral hemp for this condition. More evidence is needed to rate hemp for these uses.

(Read more about HEMP)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Diabetes. It is unclear if oral stevia is beneficial in patients with diabetes; the available research is conflicting. Details: A small single-dose study shows that taking stevia leaf extract 1000 mg, standardized to contain 91% stevioside, along with a meal reduces postprandial glucose levels by 18% in adults with type 2 diabetes when compared with a starch control (11812). However, clinical research in patients with type 1 or type 2 diabetes shows that taking stevioside 250 mg three times daily for 3 months does not affect blood glucose levels or glycated hemoglobin (HbA1C) when compared with baseline (16705). Also, a small clinical study in patients with diabetes shows that drinking 200 mL of black tea, sweetened with stevia extract 2%, three times daily for 8 weeks does not affect glycemic indices when compared with drinking tea sweetened with sucralose (103695).
• Hypertension. It is unclear if oral stevia is beneficial in patients with hypertension; the available research is conflicting. Details: Some clinical research in patients with mild to moderate hypertension shows that taking stevioside, a constituent of stevia, 750-1500 mg in three divided doses daily reduces systolic blood pressure by 10-14 mmHg and diastolic blood pressure by 6-14 mmHg within one week to three months of treatment initiation and continuing for up to 2 years (11809,11810). However, other clinical research in patients with mild hypertension shows that taking stevioside in doses up to 15 mg/kg daily does not significantly reduce blood pressure (16706).
• Obesity. It is unclear if oral stevia is beneficial in patients with obesity; the available research is conflicting. Details: Although a small clinical study in healthy adults shows that drinking water with stevia (Truvia) 245 ppm as a single dose reduces appetite and energy intake when compared with drinking water alone (103697), other small, single-dose studies have shown no effect of stevia 15.3 mg or 1 gram as a single dose on satiety, energy intake, or fullness when compared with either water alone or a non-nutritive sweetener (103696,110124). A small clinical study in healthy adults shows that taking an aqueous stevia leaf extract (SweetLeaf) twice daily for 12 weeks does not affect body weight, compared with an increase in weight in the control group. This suggests that stevia extract may have attenuated weight gain in this study (106458). More evidence is needed to rate stevia for these uses.

(Read more about STEVIA)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Aging skin. It is unclear if oral sweet almond is beneficial in patients with aging skin. Details: Preliminary clinical research in postmenopausal females shows that consuming sweet almonds as 20% of daily energy intake for 16 weeks reduces wrinkle severity scores by approximately 8% when compared with consuming a calorie-matched snack (101756).
• Atopic dermatitis (eczema). Topical sweet almond oil has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients with xerotic eczema shows that applying an emollient containing lactic acid 5% and refined sweet almond oil 10%, with or without polidocanol 5%, twice daily (Antidry Lotion or Antidry Calm) for 2 weeks reduces itching by up to 69% when compared with baseline. Benefits occurred within 30 minutes of the first use and seemed to be related to improved moisture and lipid content of the skin (101788).
• Attention deficit-hyperactivity disorder (ADHD). It is unclear if oral sweet almond extract is beneficial in patients with ADHD. Details: Preliminary clinical research in children aged 6-14 years old with ADHD shows that taking sweet almond extract syrup, 5 mL three times daily, for 8 weeks does not affect parent- or teacher-rated hyperactivity or inattention scores when compared with methylphenidate 1 mg/kg orally daily. This study may have been inadequately powered to detect a difference between groups (101783).
• Cancer. Although there has been interest in using oral sweet almond for cancer, there is insufficient reliable information about the clinical effects of sweet almond for this purpose.
• Cardiovascular disease (CVD). Although there has been interest in using oral sweet almond for CVD, there is insufficient reliable information about the clinical effects of sweet almond for this purpose.
• Coronary heart disease (CHD). It is unclear if oral sweet almond is beneficial for the prevention or treatment of CHD. Details: A small clinical trial in patients with hypercholesterolemia has found that intake of sweet almonds for 4 weeks is associated with decreased CHD risk based on the Framingham 10-year risk score. Each 30-gram intake of sweet almonds was associated with an estimated 3.5% decrease in risk scores (99940). In 2003, the US Food and Drug Administration (FDA) determined that it would allow a qualified health claim stating that consuming 1.5 ounces of almonds per day, as part of a diet low in saturated fat and cholesterol, may reduce the risk of CHD. However, the FDA has concluded that this claim is based on supporting, rather than conclusive, evidence (102331). It is unclear if sweet almonds improve outcomes in patients with CHD. Preliminary clinical research in adults with CHD shows that incorporating sweet almonds 85 grams daily into a National Cholesterol Education Program (NCEP) Step I diet for 6 weeks does not improve total or low-density lipoprotein (LDL) cholesterol, blood pressure, vascular function, or inflammatory markers when compared to the NCEP Step 1 diet without sweet almonds (99938). However, the short duration of this study limits the validity of the findings.
• Constipation. It is unclear if oral or topical sweet almond is beneficial in patients with constipation. Details: A small single-blinded clinical study in older adults with constipation shows that taking sweet almond oil 9 mL twice daily or abdominal massage with 18 mL of sweet almond oil every other day for 2 weeks both independently improve symptoms of constipation, stool consistency, and quality of life when compared with no treatment. Improvement in constipation and quality of life were also superior with oral sweet almond oil over sweet almond oil massage (111392). The validity of these findings is limited by a lack of placebo control.
• Diabetes. It is unclear if oral sweet almond is beneficial in patients with diabetes. Details: Research on whether sweet almond improves glycemic control in patients with diabetes is conflicting. A small study in patients with type 2 diabetes and mild hyperlipidemia shows that consuming sweet almonds as 20% of energy intake (approximately 60 grams daily) as part of a National Cholesterol Education Program (NCEP) Step II diet for 4 weeks, along with hypoglycemic medications, improves measures of glycemic control, as well as lipids and adiposity. Fasting insulin and glucose levels decreased by 4% and 1%, respectively, when compared with the diet without sweet almonds. Also, low-density lipoprotein (LDL) cholesterol levels were reduced by about 12% (99941). Preliminary clinical research also shows that regularly consuming sweet almonds as part of a low-carbohydrate diet for 12 weeks is more effective than consuming cheese, but no more effective than peanuts, for reducing glycated hemoglobin (HbA1c) levels (99943,101787). However, the change in HbA1c demonstrated in these small trials may not be considered clinically relevant. In contrast, meta-analyses of many clinical trials in patients with a variety of metabolic disorders, including diabetes, shows that eating almonds 5-85 grams daily, or as 10% to 20% of energy, for 4-24 weeks does not improve fasting blood glucose levels, HbA1c, insulin levels, or measures of insulin resistance when compared with control (109019,111395).
• Hyperlipidemia. Small clinical studies suggest that oral sweet almond might reduce total cholesterol and low-density lipoprotein (LDL) cholesterol in patients with hyperlipidemia, but it does not appear to improve other lipid levels in these patients. Details: Several small clinical studies in adults with hyperlipidemia show that consuming raw sweet almonds 42.5-100 grams or taking sweet almond oil 10 mL daily for 4-9 weeks reduces low-density lipoprotein (LDL) cholesterol levels by 3% to 15% when compared with control diets or baseline levels. Most of these studies failed to show improvements in high-density lipoprotein (HDL) cholesterol levels or triglyceride levels when compared with control (76725,76737,99939,101786), although one study showed a 4% improvement in HDL levels (99940). A meta-analysis of 8 clinical trials in patients with hyperlipidemia or in which at least half of the patients were classified as having hyperlipidemia shows that consuming sweet almonds or taking sweet almond oil daily for 4-12 weeks modestly reduces total cholesterol and LDL cholesterol but does not improve very low-density lipoprotein (VLDL) cholesterol, triglycerides, or HDL cholesterol when compared with placebo or no treatment (111395).
• Hypertension. It is unclear if oral sweet almond is beneficial in patients with hypertension. Details: A meta-analysis of 10 small clinical studies in which at least half of the patients in each study were classified as having hypertension at baseline shows that taking sweet almond does not improve systolic or diastolic blood pressure when compared with placebo or no treatment (111395). The validity of these findings is limited by a high degree of heterogeneity across the studies.
• Insomnia. It is unclear if oral sweet almond is beneficial in patients with insomnia. Details: Preliminary clinical research in students shows that consuming ten sweet almonds daily for 2 weeks reduces the percentage of students reporting insomnia on sleep surveys from 78% to 69% (101784). The validity of this study is limited by the lack of a control group.
• Impaired glucose tolerance (prediabetes). It is unclear if oral sweet almond is beneficial in patients with prediabetes. Details: A small clinical study in adults with prediabetes shows that consuming 20 grams of sweet almonds 30 minutes before breakfast, lunch, and dinner daily for 3 months reduces fasting blood glucose and glycated hemoglobin (HbA1c) by 6 mg/dL and 0.4%, respectively, and improves measures of insulin resistance when compared with a control group. For every 4 patients consuming sweet almonds, one additional patient experienced normalization of HbA1c. Body weight, body mass index (BMI), total cholesterol, and low-density lipoprotein (LDL) cholesterol were also improved with sweet almond over control (111389).
• Irritable bowel syndrome (IBS). It is unclear if oral sweet almond flour is beneficial in patients with IBS. Details: Preliminary clinical research in patients with diarrhea-predominant IBS shows that taking sweet almond flour 40 grams orally daily for 20 days does not improve IBS symptom scores when compared with a wheat flour placebo. In fact, those taking sweet almond flour experienced an increase in severity of pain and the number of bowel movements (101785).
• Obesity. It is unclear if oral sweet almond is beneficial in patients with obesity. Details: A moderate-sized clinical study in adults with overweight and obesity shows that consuming 30-50 grams of sweet almonds does not reduce self-reported appetite ratings or subsequent short-term energy intake despite favorable changes in appetite-regulating hormones when compared with a carbohydrate-rich snack as a control (111388). Other preliminary clinical research in adults with overweight or obesity shows that following a calorie-restricted diet with almonds as 15% of total daily energy for 12 weeks increases fat loss by 2.4-fold, but does not affect total weight loss, when compared with a nut-free, calorie-restricted diet (99937). Another preliminary clinical study in mainly overweight individuals shows that consuming sweet almonds 56 grams daily for 4 weeks in addition to the regular diet reduces levels of total and low-density lipoprotein (LDL) cholesterol by approximately 5% when compared with eating isocaloric cookies. However, there was no effect on body weight, body composition, glycemic control, or blood pressure (101790).
• Psoriasis. Although there has been interest in using topical sweet almond oil for psoriasis, there is insufficient reliable information about the clinical effects of sweet almond for this purpose.
• Radiation dermatitis. It is unclear if topical sweet almond ointment is beneficial in patients with radiation dermatitis. Details: Preliminary clinical research in females receiving radiation therapy for breast cancer shows that topical use of a sweet almond ointment once before each treatment and once a few hours after each treatment does not prevent radiation dermatitis when compared with chamomile extract cream (76740).
• Stretch marks (striae gravidarum). It is unclear if topical sweet almond oil is beneficial in patients with stretch marks. Details: Preliminary clinical research in nulliparous patients shows that topical application of sweet almond oil twice daily, starting at gestational week 16 and continued until delivery, does not reduce the size or number of stretch marks when compared with control. However, using the sweet almond oil modestly reduced itching scores (97322). More evidence is needed to rate sweet almond for these uses.

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POSSIBLY SAFE ...when used orally and appropriately, short-term. Acai pulp, in a dose of up to 162.5 grams daily, has been used with apparent safety for up to 3 months in clinical research (17731,99400). There is insufficient reliable information available about the safety of acai when used topically.

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

(Read more about ACAI)

LIKELY SAFE ...when used orally in amounts commonly found in foods (104531,104532).

POSSIBLY SAFE ...when used orally and appropriately in medicinal amounts, short-term. Chia has been used safely at doses up to 40 grams daily for up to 6 months (16124,97940). ...when used topically, short-term. A product containing chia seed oil 4% has been applied to the skin safely for up to 8 weeks (25537).

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

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LIKELY SAFE ...when used orally and appropriately for medicinal purposes, short-term. Flaxseed oil has been used safely in doses up to 2 grams daily for up to 6 months. Higher doses of up to 24 grams daily has been safely used for up to 7 weeks (845,3912,5898,14443,16789,16791,16794,16795,17523,101951,101952,101955).

POSSIBLY SAFE ...when used topically for medicinal purposes, short-term. Flaxseed oil has been used safely on the wrist for up to 4 weeks (25691). ...when used in eye drops twice daily for up to 90 days (101953).

CHILDREN: POSSIBLY SAFE
when used orally and appropriately, short-term. Some evidence suggests that flaxseed oil, providing 200 mg of alpha-linolenic acid, can be safely used in children for up to 3 months (14443).

PREGNANCY: POSSIBLY SAFE
when used orally and appropriately for medicinal purposes, short-term. Although flaxseed oil has been used with apparent safety in clinical research in doses of 1-2 grams daily for up to 6 weeks (96432,101957), some population research has found that consuming flaxseed oil during the second and third trimesters of pregnancy is associated with a four-fold increased risk of premature birth (16797).

LACTATION:
Insufficient reliable information available; avoid using.

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LIKELY SAFE ...when hemp seed, hemp protein, and hemp seed oil are used orally in food amounts. Hulled hemp seed, hemp seed protein powder, and hemp seed oil are generally recognized as safe (GRAS) in the US (100531).

POSSIBLY SAFE ...when hemp seed oil is used orally and appropriately as medicine, short-term. Hemp seed oil in doses of 2-6.3 grams daily has been safely used for 3-6 months (88183,16791,101145). Hemp seed oil in doses of 30 mL (27.6 grams) daily has been used safely for 2 months (101125). There is insufficient reliable evidence available about the safety of hemp oil, flowers, or leaves.

CHILDREN:
There is insufficient reliable information available about the safety of hemp in children. Adverse effects have been noted in case reports, but details related to specific hemp products are limited (101153,110287).

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

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LIKELY SAFE ...when certain stevia constituents, including stevioside and rebaudiosides A, D, and M, are used orally as sweeteners in foods. These constituents have generally recognized as safe (GRAS) status in the US for this purpose (16699,16700,16702,16705,16706,108049). The stevia constituent stevioside has been safely used in doses of up to 1500 mg daily for 2 years (11809,11810,11811). There is insufficient reliable information available about the safety of whole stevia or stevia extracts when used orally. The European Food Safety Authority (EFSA) has determined that the acceptable intake of steviol glycosides is 4 mg/kg daily (106456); however, it is unclear how this relates to the use of whole stevia or stevia extract.

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

(Read more about STEVIA)

LIKELY SAFE ...when used in amounts commonly found in foods. Sweet almond is commonly eaten as a food (99937,99938,99939,99941). There is insufficient reliable information available about the safety of sweet almond when used orally or topically in medicinal amounts.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using in amounts greater than those commonly found in foods.

(Read more about SWEET ALMOND)

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking acai with antidiabetes drugs might interfere with glycemic control.  Details Preliminary clinical research in healthy adults has shown that taking acai may increase or decrease levels of fasting blood glucose (17731,105321).

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ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, using flaxseed oil in combination with anticoagulant or antiplatelet drugs might have additive effects and increase the risk of bleeding.  Details Small clinical studies show that consuming flaxseed oil might decrease platelet aggregation and increase bleeding time (5898,21912).

ANTIHYPERTENSIVE DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, combining flaxseed oil with other antihypertensive drugs might have additive effects and increase the risk of hypotension.  Details Some clinical evidence suggests that long-term consumption of flaxseed oil can modestly lower systolic and diastolic blood pressure, while other clinical research shows no effect (16793,96426,101941,101954,111063,111067).

EZETIMIBE (Zetia) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = B Concomitant use of flaxseed oil and ezetimibe reduces the absorption of alpha-linolenic acid from flaxseed oil.  Details In one clinical study, concomitant consumption of ezetimibe 10 mg daily with flaxseed oil 2 grams providing 1 gram of alpha-linolenic acid daily blocked the absorption of alpha-linolenic acid, resulting in an overall reduction in alpha-linolenic plasma levels from baseline (96433).

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ACE INHIBITORS (ACEIs) Interaction Rating = Minor Be watchful with this combination. Severity = Moderate •  Occurrence = Unlikely •  Level of Evidence = D Theoretically, consuming hemp seed protein isolate with ACE inhibitors might have additive effects and increase the risk of hypotension.  Details Hemp seed protein hydrolysate has shown ACE inhibitor-like effects in a hypertensive animal model (101136). However, hempseed oil consumption does not seem to reduce blood pressure in humans (101144). Until more is known, monitor blood pressure and potassium levels.

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, hemp seed might increase the risk of bleeding when used concomitantly with anticoagulant/antiplatelet drugs.  Details In animal research, hemp seed at 5% of the diet inhibits platelet aggregation in vitro (101137). However, in human research, taking hemp seed oil 2 grams daily for 12 weeks does not inhibit the aggregation of platelets in vitro (16791).

ANTIHYPERTENSIVE DRUGS Interaction Rating = Minor Be watchful with this combination. Severity = Moderate •  Occurrence = Unlikely •  Level of Evidence = D Theoretically, hemp seed protein may have additive effects with antihypertensive drugs.  Details In a hypertensive animal model, hemp seed protein hydrolysate reduced systolic blood pressure by a mechanism possibly involving the inhibition of renin and angiotensin converting enzyme (ACE) activities. However, there was no effect of hemp seed protein on blood pressure in normotensive animals (101136). Furthermore, hempseed oil consumption does not seem to reduce blood pressure in humans (101144).

ESTROGENS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, hemp might interfere with hormone therapy due to its estrogenic effects.  Details In an ovariectomized animal model, a diet containing hemp seed 1%, 2%, or 10% resulted in normalized plasma levels of 17-beta-estradiol (101132). The mechanism of action for this effect is unclear.

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ANTIDIABETES DRUGS Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, stevia might increase the risk for hypoglycemia when combined with antidiabetes drugs.  Details Preliminary clinical research in patients with type 2 diabetes suggests that taking a single dose of stevia extract 1000 mg reduces postprandial blood glucose levels when taken with a meal (11812). However, other clinical research in patients with type 1 or type 2 diabetes suggests that taking stevioside 250 mg three times daily does not significantly affect blood glucose levels or glycated hemoglobin (HbA1C) after three months of treatment (16705).

ANTIHYPERTENSIVE DRUGS Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, combining stevia or stevia constituents with antihypertensive agents might increase the risk of hypotension.  Details Stevia extract and stevioside might lower blood pressure in patients with hypertension (3745,3747,5031,11809,11810). However, other clinical research suggests that stevioside does not significantly lower blood pressure in patients with hypertension (16706).

LITHIUM Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, stevia might decrease clearance and increase levels of lithium.  Details Animal research suggests that stevia extracts might have diuretic activity (3746,3747). Theoretically, increased reabsorption of lithium along with sodium might reduce excretion and increase levels of lithium.

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(Read more about SWEET ALMOND)

General ...Orally, acai seems to be well tolerated.

Other ...Raw acai fruit and juice can be contaminated with a parasitic protozoan called Trypanosoma cruzi, which causes American trypanosomiasis or Chagas Disease. A Brazilian outbreak of this disease in 2006 was linked to consumption of acai juice (17194,30245).

(Read more about ACAI)

General ...Orally and topically, chia seems to be well tolerated.
Most Common Adverse Effects:
Orally: Flatulence and soft stools.
Serious Adverse Effects (Rare):
Orally: Anaphylaxis in sensitive individuals.

Cardiovascular ...Chia contains a high concentration of alpha-linolenic acid (ALA). There is some concern that ALA might increase triglyceride levels more than other omega-3 fatty acids (12918); however, clinical research with a specific variety of chia called Salba shows that it does not significantly increase triglyceride levels (16124).

Gastrointestinal ...Orally, chia might cause mild gastrointestinal adverse effects. Some patients consuming chia 40 grams daily for up to 6 months reported mild and transient gastrointestinal adverse effects such as flatulence and soft stools; however, the frequency of these adverse effects was similar to patients consuming an oat bran control (97940). Bloating and flatulence have been reported with a chia flour-based sports beverage (112385).

Immunologic ...Orally, chia might cause anaphylaxis in sensitive individuals. A single case of IgE-mediated anaphylactic reaction has been reported for a patient who consumed chia seeds. Symptoms, including pruritus in the mouth, urticaria, facial angioedema, shortness of breath, and dizziness, developed a few days after consuming chia seeds. The reaction was attributed to sensitivity to proteins in chia seeds (91517).

Oncologic ...Chia seeds contain a high concentration of alpha-linolenic acid (ALA). Epidemiologic research suggests that high dietary intake of ALA might increase risk for prostate cancer (1337,2558,7823,7147,12978). Other research suggests high intake or serum levels of ALA does not increase the overall risk of prostate cancer (12961,15736); however, it might increase the risk of advanced prostate cancer (12961). Association with prostate cancer appears to depend on the sources of ALA. Dairy and meat sources have been positively associated with prostate cancer, whereas plant sources, such as chia seed, don't seem to affect prostate cancer risk (12909). According to a clinical trial, intake of ALA does not appear to increase levels of prostate specific antigen (PSA) (91402).

(Read more about CHIA)

General ...Orally, flaxseed oil is generally well tolerated. Topically, flaxseed oil seems to be well-tolerated.
Most Common Adverse Effects:
Topically: Itching, redness.
Serious Adverse Effects (Rare):
Orally: Severe allergic reactions such as anaphylaxis.

Endocrine ...Orally, flaxseed oil might cause gynecomastia. In a case report, a 70-year-old male developed gynecomastia after taking flaxseed oil daily for 3 months. Discontinuing flaxseed oil lead to resolution of gynecomastia (105478).

Gastrointestinal ...Orally, flaxseed oil may cause a change in bowel habits, dry mouth, and dyspepsia when taken at a dose of about 5 grams daily. However, these effects have been reported by only a small number of patients (approximately 3%) (16794). High doses of flaxseed oil (30 grams per day and higher) have been associated with loose stools and diarrhea (5898,11025).

Immunologic ...Severe allergic reactions such as anaphylaxis have been reported with flaxseed oil ingestion and also in workers processing flaxseed products (6809).

Ocular/Otic ...Topically, eye drops containing flaxseed oil may cause redness and itching (101953).

Oncologic ...Flaxseed oil has not been linked to increased prostate cancer risk. Although epidemiologic research has found that high dietary intake of alpha-linolenic acid (ALA) is associated with increased prostate cancer risk (1337,2558,7147,7823,12978), this risk does not seem to apply to ALA from plant sources, like flaxseed (12909).

(Read more about FLAXSEED OIL)

General ...Orally, hemp products are generally well tolerated in food amounts. In larger amounts, hemp seed oil seems to be well tolerated.
Serious Adverse Effects (Rare):
Orally: Rare cases of anaphylaxis have been reported. Long QT syndrome, torsades de pointes, and syncope have also been reported rarely.

Cardiovascular ...Acquired long QT syndrome, torsades de pointes, and syncope have been reported in a 56-year-old woman following the intake of supplements containing hemp oil. The hemp supplements provided cannabidiol (CBD), and possibly cannabigerol (CBG). Although the exact dose is unknown, up to six times the recommended dose had been used for approximately 6 weeks, in combination with a supplement containing berberine. While hospitalized, intravenous magnesium and saline were used to stabilize heart rhythm. It is unknown whether this adverse effect was related to the hemp oil, berberine, or their interaction (110104).

Hepatic ...Orally, there is a case report of elevated liver enzymes and hepatitis in a two-year-old boy given hemp extract 2. 5 mL, providing 125 mg phytocannabinoid, five to eight times daily for infantile spasms and refractory seizures. The total dose of phytocannabinoids was approximately 60-100 mg/kg daily (110287).

Immunologic ...Orally, there are case reports of allergy to hemp seed, although this is uncommon (101140,101154). A 44-year-old male developed hives during a meal of hemp seed-crusted seafoods. Later, he developed facial swelling, shortness of breath, and problems speaking. Evaluation revealed allergy to a specific protein in hemp seed. He did not react to smoked cannabis (101140). In other cases, anaphylaxis, facial swelling, and worsening asthma have been reported in association with a first exposure to hemp seed, although some had smoked cannabis previously (101154).
Topically, a case of patch-test confirmed allergic contact dermatitis to hemp seed oil has been reported in a 22-year-old woman. The initial rash started at the application point on her back and spread to her arms, hands, and neck (110288).
Airborne exposure to hemp pollen is a relatively common cause of allergic respiratory symptoms in some locations (101155).

Neurologic/CNS ...Orally, cases of acute cannabinoid toxicity with neurological symptoms in children and adults have been associated with intake of hemp seed oil. There is a case report of decreased alertness, stupor, bloodshot eyes, and fixed gaze in a 2-year-old male probably related to the intake of one teaspoon hemp seed oil (CANAH) containing 0.06% delta-9-tetrahydrocannabinol (THC) twice daily for 3 weeks. After stopping the oil, irritability was reported over the next few days (101153).

(Read more about HEMP)

General ...Orally, stevia and steviol glycosides appear to be well tolerated. Most minor adverse effects seem to resolve after the first week of use.
Most Common Adverse Effects:
Abdominal bloating, dizziness, headache, myalgia, nausea, and numbness.
Serious Adverse Effects (Rare):
Allergic reactions.

Gastrointestinal ...Orally, stevia and steviol glycosides such as stevioside, can cause gastrointestinal adverse effects such as abdominal fullness and nausea. However, these generally resolve after the first week of use (11809,11810).

Immunologic ...Theoretically, stevia might cause allergic reactions in individuals sensitive to plants in the Asteraceae/Compositae family (11811). Members of this family include ragweed, chrysanthemums, marigolds, daisies, and many other herbs.

Musculoskeletal ...Orally, stevia and steviol glycosides may cause myalgia, but this generally resolves after the first week of use (11809,11810).

Neurologic/CNS ...Orally, stevia and steviol glycosides may cause headache, dizziness, and numbness (11809,11810).

(Read more about STEVIA)

General ...Orally, when consumed as food, sweet almond is well tolerated. Orally and topically, when used as medicine, adverse effects from sweet almond seem to be rare; however, a thorough safety evaluation has not been conducted.
Most Common Adverse Effects:
Orally: Allergic reactions.
Topically: Dermatitis, itching.

Dermatologic ...Topically, itching, dermatitis, and worsening eczema have been reported in a clinical trial (101788).

Immunologic ...Tree nuts, which include almonds, can cause allergic reactions in sensitive individuals. Due to the prevalence of this allergy in the general population, tree nuts are classified as a major food allergen in the United States (105410).

Neurologic/CNS ...Orally, adverse effects to sweet almond extract in syrup have included increased sleep (101783).

Other ...Orally, adverse effects to sweet almond extract in syrup have included increased appetite (101783).

(Read more about SWEET ALMOND)