SP Green Food by SP Standard Process

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Diabetes. Although there has been interest in using oral alfalfa for diabetes, there is insufficient reliable information about the clinical effects of alfalfa for this purpose.
• Dyspepsia. Although there has been interest in using oral alfalfa for dyspepsia, there is insufficient reliable information about the clinical effects of alfalfa for this purpose.
• Hypercholesterolemia. It is unclear if oral alfalfa seeds are beneficial in patients with hypercholesterolemia. Details: A small, uncontrolled clinical study in patients with hypercholesterolemia shows that taking heat-prepared alfalfa seeds 40 grams three times daily for 8 weeks reduces total cholesterol and low-density lipoprotein (LDL) cholesterol levels when compared to baseline (5816). The validity of these findings is limited by the lack of a control group.
• Menopausal symptoms. Although there has been interest in using oral alfalfa for menopausal symptoms, there is insufficient reliable information about the clinical effects of alfalfa for this purpose. There is insufficient reliable information available about the effectiveness of alfalfa for its other uses.

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LIKELY EFFECTIVE

• Coronary heart disease (CHD). Consuming barley 3-3.6 grams daily as a source of dietary fiber appears to reduce the risk of CHD. Details: Clinical research shows that a diet containing foods high in soluble fiber, such as whole grain barley or dry milled barley, reduces the risk of heart disease (2737,4962,4963,4964,4965,4966,4967,4968). In 1993, the US Food and Drug Administration (FDA) approved a health claim stating that consuming at least 3 grams of soluble fiber per day, as part of a diet low in saturated fat and cholesterol, may reduce the risk of CHD (5792,5797,102336). However, some clinical research shows that at least 3.6 grams of soluble fiber daily is needed to reduce the risk of CHD (5788,5795).
• Hypercholesterolemia. Consuming barley 3-12 grams daily seems to reduce total cholesterol and low-density lipoprotein (LDL) cholesterol levels in adults with hypercholesterolemia. Details: Clinical research shows that taking barley significantly reduces total cholesterol and low-density lipoprotein (LDL) cholesterol when used with a normal diet or added to the National Cholesterol Education Program's Step I diet (11134,11986,17129,33734,33748,33752). A meta-analysis of 11 clinical trials shows that consuming preparations containing barley 3-12 grams daily for at least 4-12 weeks reduces total cholesterol and LDL cholesterol levels by around 12 mg/dL and 10 mg/dL, respectively, with no change in triglyceride or high-density lipoprotein (HDL) cholesterol levels. These changes did not appear to be dose-dependent (17129). However, a small clinical study in males with hypercholesterolemia shows that the effect of barley on cholesterol is modestly dose-dependent. Taking 0.4 grams, 3 grams, or 6 grams of soluble fiber from barley daily for 5 weeks reduces total cholesterol by 14%, 17%, and 20%, respectively, and reduces LDL cholesterol by 17%, 17%, and 24%, respectively, when compared to baseline (11986). The form of barley used may alter its effect on cholesterol levels. Some research has shown that barley highly enriched (75% by weight) with beta-glucans does not seem to significantly affect cholesterol. This lack of effect seems to be the result of processing the barley into a highly enriched beta-glucans product (10166). Food processing seems to affect beta-glucans structure or solubility and therefore decreases the cholesterol lowering effects of barley.

POSSIBLY INEFFECTIVE

• Colorectal cancer. Increased consumption of barley as a source of fiber does not appear to be beneficial for primary or secondary prevention of colorectal cancer. Details: Clinical and observational research shows that consuming dietary cereal fiber, including barley fiber, does not reduce the risk of colorectal cancer or prevent colorectal cancer recurrence (160,4819,4820,4821,5104).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Coronavirus disease 2019 (COVID-19). It is unclear if oral barley is beneficial in patients with COVID-19. Details: A small clinical study in Iranian adults hospitalized with moderate COVID-19 shows that drinking 250 mL of Persian barley water daily for 2 weeks, along with conventional treatment, decreases length of hospital stay, body temperature, and markers of inflammation when compared with conventional treatment alone. However, Persian barley water does not appear to improve oxygen saturation or symptoms of COVID-19 (111148). The validity of these findings is limited by a lack of placebo control and concerns related to the statistical methods used.
• Diabetes. Although there has been interest in using oral barley for diabetes, there is insufficient reliable information about the clinical effects of barley for this purpose.
• Diarrhea. Although there has been interest in using oral barley for diarrhea, there is insufficient reliable information about the clinical effects of barley for this purpose.
• Gastric cancer. It is unclear if oral barley is effective for the prevention of gastric cancer. Details: Observational research suggests that increased consumption of dietary fiber, a component of barley, is associated with 70% lower odds of gastric cancer when compared with low consumption of dietary fiber (10435).
• Gastritis. Although there has been interest in using oral barley for gastritis, there is insufficient reliable information about the clinical effects of barley for this purpose.
• Hypertension. Although there has been interest in using oral barley for hypertension, there is insufficient reliable information about the clinical effects of barley for this purpose.
• Obesity. Although there has been interest in using oral barley for obesity, there is insufficient reliable information about the clinical effects of barley for this purpose.
• Ulcerative colitis. Small clinical studies suggest that oral barley might improve symptoms associated with ulcerative colitis. Details: Several small, open-label trials in patients with ulcerative colitis show that consuming food containing germinated barley 20-30 grams daily for 4-24 weeks reduces symptoms of ulcerative colitis when compared to baseline (33725,33729,33732,33777). However, the validity of these findings is limited by a lack of comparator groups. Barley has also been studied in combination with other ingredients. A small clinical study in adults with mild to moderate ulcerative colitis shows that taking a specific nutritional supplement (Profermin, Nordisk Rebalance) containing barley malt flour, oat flour, Lactobacillus plantarum, and lecithin twice daily for 8 weeks decreases symptom scores by at least 50% in an additional 26% of patients when compared with a control nutritional supplement. Disease remission occurred in 31% of patients taking this product compared with 15% of patients in the control group (92818). It is unclear if these findings are due to barley, other ingredients, or the combination. More evidence is needed to rate barley for these uses.

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INSUFFICIENT RELIABLE EVIDENCE to RATE

• Benign prostatic hyperplasia (BPH). Population research has found that higher intake of Brussels sprout is not associated with significantly reduced risk of BPH (26190).
• Bladder cancer. Epidemiologic research has found that eating about 1 cup daily of cruciferous vegetables, such as cabbage, Brussels sprout, cauliflower, broccoli, kale, or collards, is associated with a 30% lower risk of developing bladder cancer in adults (14864). Other population research has found that higher intake of cruciferous vegetables, such as cauliflower, Brussels sprout, cabbage, broccoli, and kale, is associated with a 51% reduction in the risk of developing bladder cancer in males. However, higher intake of Brussels sprout alone does not seem to be associated with a reduced risk of bladder cancer (26184).
• Breast cancer. Some population research has found that higher intake of cruciferous vegetables, including broccoli, Brussels sprout, cabbage, cauliflower, collards, and kale, is associated with a slight increase in the risk of breast cancer in premenopausal adults, while higher intake appears to be associated with a slight but statistically insignificant decrease in the risk in postmenopausal adults (26188). However, other population research has found that higher intake of Brussels sprout alone is not associated with a reduced risk of breast cancer (26189). Cruciferous vegetables might increase urinary levels of 2-hydroxyestrone, and its ratio to 16-alpha-hydroxyestrone, which could reduce the risk of breast cancer. However, research in pre-menopausal adults shows that taking a dried Brussels sprout and kale supplement, 3.3 grams daily for 8 weeks, or increasing dietary intake of Brussels sprout or broccoli by one 40-gram serving daily, does not increase urinary levels of 2-hydroxyestrone, or its ratio to 16-alpha-hydroxyestrone, when compared with placebo (112086).
• Diabetes. Population research has found that higher intake of cruciferous vegetables, including broccoli, cabbage, cauliflower, and Brussels sprout, is not associated with a reduced risk of developing type 2 diabetes (26187). A meta-analysis of 23 studies shows that the highest levels of combined vegetable and fruit intake are associated with a 7% reduction in the risk of developing type 2 diabetes, when compared with the lowest intakes, but higher intake of Brussels sprout alone is associated with a 7% increase in the risk (112088).
• Hypertension. A meta-analysis of 18 studies in healthy adults shows that the highest levels of combined vegetable and fruit intake are associated with a 9% to 11% reduction in the risk of developing hypertension, when compared with the lowest intakes, but higher intake of Brussels sprout alone is associated with a 25% increase in the risk (112087).
• Lung cancer. Population research has found that people who consume Brussels sprout and broccoli at least once weekly have a 22% lower risk of developing lung cancer when compared with those who consume these vegetables less than once monthly (26192).
• Non-Hodgkin lymphoma. Population research has found that females who consume at least half a serving of Brussels sprout or other cruciferous vegetables daily have a lower risk of developing non-Hodgkin lymphoma, particularly the follicular lymphoma subtype, when compared to those who eat these vegetables less often. However, eating Brussels sprout and other cruciferous vegetables does not appear to be associated with a reduced risk of non-Hodgkin lymphoma in males (26186).
• Pancreatic cancer. Population research has found that consuming higher amounts of Brussels sprout is not associated with a reduced risk of pancreatic cancer (26181).
• Prostate cancer. Population research has found that people who consume higher amounts of Brussels sprout and other cruciferous vegetables have a lower risk of developing prostate cancer (25420,25421).
• Stroke. Population research has found that higher intake of Brussels sprout and other cruciferous vegetables is associated with a 32% reduction in the risk of ischemic stroke (7394). More evidence is needed to rate Brussels sprout for these uses.

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INSUFFICIENT RELIABLE EVIDENCE to RATE

• Cardiovascular disease (CVD). A meta-analysis of clinical research shows that taking buckwheat seems to improve some, but not all, markers of CVD risk. Buckwheat was found to decrease total cholesterol by 19 mg/dL, triglycerides by 22 mg/dL, and blood glucose by 15 mg/dL, but had no effect on blood pressure, body weight, insulin, or low-density lipoprotein (LDL) cholesterol when compared with a control group (100947). The patient populations included in this analysis ranged from healthy adults to those with diabetes or hyperlipidemia; it's unclear whether the results are consistent across patient groups or if the benefits are more pronounced in certain types of patients. The effects of buckwheat on cardiovascular events, such as myocardial infarction, stroke, or cardiovascular death, in patients with CVD, are unknown.
• Chronic venous insufficiency (CVI). Preliminary clinical research shows that drinking common buckwheat tea for 3 months attenuates leg swelling compared with placebo in patients with chronic venous insufficiency (37351).
• Diabetes. Preliminary clinical research shows that patients with type 2 diabetes who replace a portion of white rice or white flour with tartary buckwheat 50 grams three times daily for 4 weeks show a 3% reduction in fasting insulin and a 7% reduction in low-density lipoprotein (LDL) cholesterol compared to baseline. Patients who consume the standardized recipe containing white rice and/or white flour three times daily for 4 weeks show no significant changes in these measurements. Neither groups show improvement in fasting blood glucose or hemoglobin A1c levels (96063).
• Diabetic retinopathy. Preliminary clinical research shows that taking common buckwheat 1 gram three times daily for 3 months does not significantly improve visual acuity compared with baseline in patients with diabetic retinopathy (37358). More evidence is needed to rate the effectiveness of buckwheat for these uses.

(Read more about BUCKWHEAT)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Bladder cancer. It is unclear if consuming kale in the diet can reduce the risk of bladder cancer. Details: Population research suggests that patients with bladder cancer consumed approximately 0.18 fewer cups of cruciferous vegetables, such as cabbage, Brussels sprout, cauliflower, broccoli, kale, or collards, on a weekly basis in the year prior to diagnosis when compared with people without bladder cancer. The effects of kale, specifically, are unclear (14864). Other population research suggests that eating at least five servings per week of cruciferous vegetables, such as cauliflower, Brussels sprout, cabbage, broccoli, and kale, is associated with a 51% reduction in the risk of developing bladder cancer in males when compared with eating up to one serving per week. However, higher intake of kale alone does not seem to be associated with a reduced risk of bladder cancer (26184).
• Breast cancer. It is unclear if consuming kale in the diet can reduce the risk of breast cancer. Details: Population research suggests that the highest dietary intake of cruciferous vegetables, including broccoli, Brussels sprout, cabbage, cauliflower, collards, and kale, is associated with a slight increase in the risk of breast cancer in premenopausal adults when compared with the lowest intake (26188). Cruciferous vegetables might increase urinary levels of 2-hydroxyestrone, and its ratio to 16-alpha-hydroxyestrone, which could reduce the risk of breast cancer. However, research in pre-menopausal adults shows that taking a dried kale and Brussels sprout supplement, 3.3 grams daily for 8 weeks, or increasing dietary intake of Brussels sprout or broccoli by one 40-gram serving daily, does not increase urinary levels of 2-hydroxyestrone, or its ratio to 16-alpha-hydroxyestrone, when compared with placebo (112086). In postmenopausal adults, the highest intake of cruciferous vegetables appears to be associated with a statistically insignificant reduced risk of breast cancer (26188).
• Inflammatory bowel disease (IBD). Although there is interest in oral kale for IBD, there is insufficient reliable information available about the use of kale for this purpose.
• Menopausal symptoms. Although there is interest in oral kale for reducing menopausal symptoms, there is insufficient reliable information available about the use of kale for this purpose. More evidence is needed to rate kale for these uses.

(Read more about KALE)

POSSIBLY SAFE ...when the leaves are used orally and appropriately, short-term (4,6,12).

LIKELY UNSAFE ...when large amounts are used long-term. Chronic ingestion of alfalfa has been associated with drug-induced lupus effects (381,14828,30602).

PREGNANCY AND LACTATION: POSSIBLY UNSAFE
when used orally in medicinal amounts. Alfalfa contains constituents with possible estrogenic activity (4,11,30592).

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LIKELY SAFE ...when used orally and appropriately in food amounts (4819,4820,4821,5104,10166,10435,11134,11463,11986,92818). There is insufficient reliable information available about the safety of barley when used orally in medicinal amounts or when applied topically.

PREGNANCY: LIKELY SAFE
when used orally in amounts commonly found in foods (19).

PREGNANCY: POSSIBLY UNSAFE
when barley sprouts are consumed in relatively high doses. Excessive amounts of barley sprouts should not be consumed during pregnancy (19).

LACTATION:
Insufficient reliable information available; avoid using.

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LIKELY SAFE ...when used in amounts commonly found in foods. There is insufficient reliable information available about the safety of Brussels sprout when used in medicinal amounts.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid amounts in excess of those found in foods.

(Read more about BRUSSELS SPROUT)

POSSIBLY SAFE ...when used orally and appropriately (11438,11442).

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

(Read more about BUCKWHEAT)

LIKELY SAFE ...when used in amounts commonly found in foods. There is insufficient reliable information available about the safety of kale when used orally in medicinal amounts.

PREGNANCY AND LACTATION: LIKELY SAFE
when used orally in amounts commonly found in foods. There is insufficient reliable information available about the safety of kale when used orally in medicinal amounts; avoid use.

(Read more about KALE)

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, alfalfa might increase the risk of hypoglycemia when taken with antidiabetes drugs.  Details Animal research suggests that alfalfa decreases blood sugar in diabetic mice (30605). Also, in one case report, a diabetic patient experienced hypoglycemia after consuming alfalfa extract (30608). Monitor blood glucose levels closely. Dose adjustments might be necessary.

CONTRACEPTIVE DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, alfalfa might interfere with the activity of contraceptive drugs.  Details Alfalfa contains coumestrol, a phytoestrogen, and isoflavonoids, which have estrogenic effects (4,30592).

ESTROGENS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, alfalfa might interfere with hormone therapy.  Details Alfalfa contains coumestrol, a phytoestrogen, and isoflavonoids, which have estrogenic effects (4,30592).

IMMUNOSUPPRESSANTS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, alfalfa might decrease the efficacy of immunosuppressive therapy.  Details In vitro research and human case reports suggest that alfalfa may have immunostimulant effects (12174,14828,14829).

PHOTOSENSITIZING DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use of alfalfa with photosensitizing drugs might have additive effects.  Details Animal research suggests that excessive doses of alfalfa may increase photosensitivity, possibly due to its chlorophyll content (106043). It is unclear if this effect would be clinically relevant in humans.

WARFARIN (Coumadin) Interaction Rating = Major Do not take this combination. Severity = High •  Occurrence = Probable •  Level of Evidence = D Theoretically, alfalfa might reduce the anticoagulant activity of warfarin.  Details Alfalfa contains a large amount of vitamin K (4,6). This could theoretically interfere with the activity of warfarin.

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TRICLABENDAZOLE (Egaten) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, barley might decrease the clinical effects of triclabendazole.  Details Animal research suggests that a diet supplemented with barley can reduce the bioavailability of triclabendazole when taken concomitantly (23884). This effect has not been shown in humans.

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General ...Orally, alfalfa leaf seems to be well tolerated. However, a thorough evaluation of safety outcomes has not been conducted.
Most Common Adverse Effects:
Orally: Abdominal discomfort, diarrhea, and flatulence.
Serious Adverse Effects (Rare):
Orally: Lupus-like syndrome after chronic ingestion of alfalfa.

Dermatologic ...Dermatitis associated with alfalfa use has been reported. In a 1954 publication, dermatitis was noted in a 61-year-old female consuming 4-6 cups of tea made with two tablespoonfuls of alfalfa seeds for approximately two months prior to onset. Examination revealed diffuse, confluent edema and erythema on the face, eyelids, ears, hands, forearms, and distal humeral regions. The dermatitis improved with treatment; re-exposure to alfalfa resulted in a similar reaction (30609).

Endocrine ...Alfalfa contains constituents, including coumestrol, with reported estrogenic activity (30586,30592,4753). Effects in humans are not known.
One case report documents hypokalemia in a female who had been drinking a "cleansing tea" containing alfalfa, licorice, and stinging nettle. The potassium level returned to normal after discontinuing the tea and initiating potassium supplementation. The specific cause of the hypokalemia is not clear. Notably, both stinging nettle and licorice have been associated with hypokalemia and may have been responsible for this effect (30562).

Gastrointestinal ...Orally, flatulence and bulkier feces were reported during the first week of a case series of three subjects ingesting alfalfa (30598). In a case series of 15 patients ingesting alfalfa, increased fecal volume and increased stool frequency was reported. Additional adverse effects included abdominal discomfort in two patients, diarrhea in two patients, loose stools in six patients, and intestinal gas in 13 patients (5816).

Hematologic ...Pancytopenia and splenomegaly were reported in a 59-year-old male who had been taking 80-160 grams of ground alfalfa seeds for up to six weeks at a time, for a five month period. Hematologic values and spleen size returned to normal when alfalfa was discontinued (381).

Other ...Alfalfa products, including sprouts, seeds, and tablets, have been found to be contaminated with Escherichia coli, Salmonella, and Listeria monocytogenes, which have caused documented infections (5600,30566,30568,30572,30569,30564,30604,30610,30563,30607) (30566,30564,30604,30610,30563,30607,30576).
Orally, alfalfa has been associated with the development of a lupus-like syndrome in animals and humans (30594,14828,14830,30602), as well as with possible exacerbations of lupus in patients with known systemic lupus erythematosus (SLE). These reactions may be associated with the amino acid L-canavanine (30594), which appears to be present in alfalfa seeds and sprouts, but not leaves, and therefore should not be present in alfalfa tablets manufactured from the leaves (30601). However, case reports have included individuals ingesting tablets. A lupus-like syndrome was described in four patients taking 12-24 alfalfa tablets per day. Symptoms included arthralgias, myalgias, and rash; positive antinuclear antibodies (ANA) arose anywhere from three weeks to seven months after initiating alfalfa therapy. Upon discontinuation of alfalfa tablets, all four patients became asymptomatic. In two patients, ANA levels normalized (14828). Two additional reports have documented possible exacerbation or induction of SLE associated with alfalfa use. One case involved a female with a 26-year history of SLE, who had been taking 15 tablets of alfalfa daily for nine months prior to an exacerbation. Because of the delay in onset of the exacerbation from the initiation of alfalfa therapy, causation cannot be clearly established (30575). In a different report, SLE and arthritis were found in multiple family members who had been taking a combination of vitamin E and alfalfa tablets for seven years (30602). It is not known what other environmental or genetic factors may have affected these individuals, and the association with alfalfa is unclear.

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General ...Orally, barley is well tolerated.
Most Common Adverse Effects:
Orally: Abdominal distension, bloating, flatulence, unpleasant taste. Allergic reactions in sensitive individuals.
Topically: Allergic reactions in sensitive individuals.

Dermatologic ...Topically, barley malt contained in beer has been reported to cause contact dermatitis (33762). After occupational exposure, barley has been reported to cause contact dermatitis of the eyelids and extremities, as well as contact urticaria (33735,33770,33774).

Gastrointestinal ...When consumed orally, barley provides fiber. Increasing fiber in the diet can cause flatulence, bloating, abdominal distention, and unpleasant taste. To minimize side effects, doses should be slowly titrated to the desired level. Adverse effects usually subside with continued use (12514).
Barley contains gluten. In patients with biopsy-proven celiac disease, consuming barley can cause gastrointestinal upset and impairment of xylose excretion (33763,33772).

Immunologic ...Orally, consumption of beer has been reported to cause allergic reactions in sensitive individuals (33722,33724). Symptoms included tingling in the face, lip, and tongue, angioedema, generalized urticaria, chest tightness, dyspnea, cough, fainting, and rhinoconjunctivitis. It can also cause anaphylaxis in sensitive individuals (317). Topically and with occupational exposure, barley has been reported to cause contact dermatitis and rash (33762,33735,33770,33774).
"Bakers' asthma" is an allergic response resulting from the inhalation of cereal flours by workers in the baking and milling industries, and has been reported to occur after barley flour exposure (1300,33756,33760). Cross-allergenicity has been shown to exist between different cereals (33758).

Pulmonary/Respiratory ..."Bakers' asthma" is an allergic response resulting from the inhalation of cereal flours by workers in the baking and milling industries, and has been reported to occur after barley flour exposure (1300,33756,33760). Cross-allergenicity has been shown to exist between different cereals (33758).
By inhalation, barley flours may be a source of allergens in asthma (33764,33773). Inhalation of wild barley grass pollen may result in bronchial irritation or pneumonitis (33726,33755).

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General ...Orally, Brussels sprout is generally well-tolerated when consumed in dietary amounts. Eating Brussels sprout or other types of fermentable carbohydrates can cause flatulence (26470).

Gastrointestinal ...Orally, eating Brussels sprout or other types of fermentable carbohydrates can cause flatulence (26470).

(Read more about BRUSSELS SPROUT)

General ...Orally, buckwheat seems to be well tolerated (11438,11442). However, allergic reactions to buckwheat can occur in some adults and children. Symptoms can include skin sensitization, allergic rhinitis, asthma, conjunctivitis, nausea, vomiting, and anaphylaxis (11435,11436,11437,96060,96061). Occupational exposure to buckwheat, or household exposure through sleeping on a buckwheat husk stuffed-pillow can cause sensitization, of which symptoms include allergic rhinitis and asthma (11437,11443).

Immunologic ...Orally, buckwheat seems to be well tolerated (11438,11442). However, allergic reactions to buckwheat can occur in some adults and children. Symptoms can include skin sensitization, allergic rhinitis, asthma, conjunctivitis, nausea, vomiting, and anaphylaxis (11435,11436,11437,96060,96061).
Occupational exposure to buckwheat, or household exposure through sleeping on a buckwheat husk stuffed-pillow can cause sensitization, of which symptoms include allergic rhinitis and asthma (11437,11443).

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General ...Orally, kale is generally well tolerated when consumed in amounts commonly found in foods. No adverse effects have been reported with medicinal use. However, a thorough evaluation of safety outcomes has not been conducted.

(Read more about KALE)