Nutra-BRL by NutraMedix

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Allergic rhinitis (hay fever). Although there is interest in using oral cat's claw for allergic rhinitis, there is insufficient reliable information about the clinical effects of cat's claw for this condition.
• Alzheimer disease. Although there is interest in using oral cat's claw for Alzheimer disease, there is insufficient reliable information about the clinical effects of cat's claw for this condition.
• Asthma. Although there is interest in using oral cat's claw for asthma, there is insufficient reliable information about the clinical effects of cat's claw for this condition.
• Atopic dermatitis (eczema). Oral cat's claw has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that using a specific spray combination of cat's claw (Uncaria tomentosa) 1% and Rhealba oat plantlet extract 0.25% (Pierre Fabre Dermo Cosmetique) up to 6 times daily for 22 days subjectively reduces skin symptoms of atopic dermatitis when compared with baseline (103170). The validity of this finding is limited by the lack of a comparator group. Additionally, it is not clear whether the results are due to cat's claw, oat extract, spray excipients, or the combination.
• Cancer. It is unclear if oral cat's claw is beneficial for improving quality of life in patients with cancer. Details: Preliminary clinical research in patients with terminal advanced solid tumors shows that taking a specific cat's claw (Uncaria tomentosa) extract, standardized to 5% mitraphylline, 100 mg three times daily for at least 8 weeks improves quality of life, social functioning, and fatigue when compared with baseline (92502). The validity of this finding is limited by the lack of a comparator group.
• Chronic fatigue syndrome (CFS). Although there is interest in using oral cat's claw for CFS, there is insufficient reliable information about the clinical effects of cat's claw for this condition.
• Denture Stomatitis. It is unclear if oral cat's claw is beneficial for the treatment of denture stomatitis. Details: In patients with denture stomatitis, a small clinical trial shows that topical application of 2.5 mL of a gel containing cat's claw (Uncaria tomentosa) 2% to the base of dentures three times daily after meals for one week is as effective as miconazole 2% for improvement of symptoms. However, these treatments were also similarly effective to placebo (105186).
• Diarrhea. Although there is interest in using oral cat's claw for diarrhea, there is insufficient reliable information about the clinical effects of cat's claw for this purpose.
• Hemorrhoids. Although there is interest in using oral cat's claw for hemorrhoids, there is insufficient reliable information about the clinical effects of cat's claw for this purpose.
• Human papillomavirus (HPV). Oral cat's claw has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that taking three tablets of a specific combination supplement containing cat's claw, echinacea, andrographis, grapefruit, papaya, and pau d'arco daily for one month reduces the recurrence of anal condylomata in patients following surgical removal of anal condylomata. After one month, recurrence was 4% in the supplement group compared with 18% in the control group; after six months the recurrence rates were 7% and 27%, respectively (20073). However, the validity of these findings is limited due to poor study methodology. Additionally, it is unclear if this effect is due to cat's claw, other ingredients, or the combination.
• Inflammatory bowel disease (IBD). Although there is interest in using oral cat's claw for ulcerative colitis and Crohn disease, there is insufficient reliable information about the clinical effects of cat's claw for these conditions.
• Osteoarthritis. It is unclear if oral cat's claw is beneficial for osteoarthritis. Details: A small clinical trial shows that taking a specific freeze-dried cat's claw (Uncaria guianensis) extract 100 mg daily orally relieves knee pain related to physical activity within one week of treatment, but does not decrease pain at rest or knee swelling (7317). Other clinical research shows that taking a specific combination supplement (Reparagen) 1800 mg twice daily for 8 weeks can reduce pain and stiffness, improve function, and reduce the need to use rescue medication similarly to glucosamine sulfate. This specific combination supplement contains cat's claw (Vincaria) 300 mg and maca (RNI 249) 1500 mg per dose (33614). It is unclear if this effect is due to cat's claw, maca, or the combination. Additionally, it is unclear how these outcomes compare to the use of placebo.
• Osteoporosis. Although there is interest in using oral cat's claw for osteoporosis, there is insufficient reliable information about the clinical effects of cat's claw for this condition.
• Psoriasis. Oral cat's claw has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that using a specific spray combination of cat's claw (Uncaria tomentosa) 1% and Rhealba oat plantlet extract 0.25% (Pierre Fabre Dermo Cosmetique) up to 6 times daily for 22 days subjectively reduces skin symptoms of psoriasis when compared with baseline (103170). The validity of this finding is limited by the lack of a comparator group. Additionally, it is not clear whether the results are due to cat's claw, oat extract, spray excipients, or the combination.
• Rheumatoid arthritis (RA). It is unclear if oral cat's claw is beneficial for RA. Details: A small clinical trial shows that taking a specific cat's claw (Uncaria tomentosa) extract 20 mg three times daily orally, containing 14.7 mg/gram pentacyclic oxindole alkaloids and no tetracyclic oxindole alkaloids, appears to modestly improve symptoms of RA. When taken orally in combination with sulfasalazine or hydroxychloroquine for 24 weeks, cat's claw seems to reduce the number of painful joints when compared with placebo. However, there is no effect on the number of swollen joints, pain, or the patient assessment of disease (8661). More evidence is needed to rate cat's claw for these uses.

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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: Clinical research in adults with overweight and obesity shows that drinking a flavored beverage (1.25-1.75 L) sweetened with stevia 660 mg daily for 12 weeks does not reduce body weight or body fat when compared with baseline, but it may avoid the weight gain that occurs in the group consuming a similar volume of flavored beverage providing sucrose 100-140 grams daily (113009). Additionally, 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). Stevia has also been examined for its effect on appetite and energy intake. 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). Additionally, a small single dose study in adults with overweight or obesity shows that drinking a beverage sweetened with stevia constituents rebaudiosides A or M in conjunction with other non-nutritive sweeteners, such as either monk fruit extract, before a meal does not reduce appetite or subsequent energy intake when compared with a beverage sweetened with sucrose (113005). More evidence is needed to rate stevia for these uses.

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POSSIBLY SAFE ...when used orally, short-term. A specific freeze-dried aqueous extract seems to be safe when used in doses of 100 mg daily for up to four weeks (7317). Another extract of cat's claw, free of tetracyclic oxindole alkaloids, seems to be safe when used in doses of 60 mg daily for up to 24 weeks (8661). There is insufficient reliable information available about the safety of cat's claw when used topically.

PREGNANCY: POSSIBLY UNSAFE
when used orally. There is concern that cat's claw might be unsafe based on its traditional use as a contraceptive (12); avoid using.

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 (11809,11810,11811,113006). 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.

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ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, cat's claw may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.  Details Cat's claw contains rhynchophylline and isorhynchophylline. Animal research suggests that these alkaloids can inhibit platelet aggregation (40220,40276). This interaction has not been reported in humans.

ANTIHYPERTENSIVE DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D Theoretically, taking cat's claw with antihypertensive drugs might increase the risk of hypotension.  Details Cat's claw contains rhynchophylline. In vitro and animal research suggests that rhynchophylline can lower blood pressure (40255,40268,40276). This interaction has not been reported in humans.

CALCIUM CHANNEL BLOCKERS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D Theoretically, taking cat's claw with calcium channel blockers might increase the risk of hypotension.  Details Cat's claw contains various alkaloids, including rhynchophylline, isorhynchophylline, corynoxeine, and isocorynoxiene. Animal research suggests that these alkaloids can lower blood pressure by acting as calcium channel blockers (40255,40268). This interaction has not been reported in humans.

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, cat's claw might increase or decrease the levels and effects of drugs metabolized by CYP3A4.  Details Cat's claw may affect the clearance of drugs metabolized by CYP3A4. In vitro research shows that cat's claw can inhibit CYP3A4 enzymes (6450,25522). In one case report, a patient taking cat's claw (at an unspecified dose) experienced increased serum levels of atazanavir, ritonavir, and saquinavir, all of which are CYP3A4 substrates. Levels returned to normal 15 days after discontinuation of the cat's claw supplement, suggesting inhibition of CYP3A4 by cat's claw (25522). In contrast, animal research suggests that rhynchophylline, an alkaloid contained in cat's claw, induces CYP3A expression and accelerates the metabolism of nirmatrelvir, the active component in the nirmatrelvir/ritonavir combination product(115308).

IMMUNOSUPPRESSANTS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, cat's claw might interfere with immunosuppressive therapy.  Details In human and laboratory research, cat's claw has been shown to have immunostimulating activity (7225,40208,40211,40212). It stimulates phagocytosis and increases respiratory cellular activity and the mobility of leukocytes. Theoretically, this could interfere with the activity of immunosuppressant medications.

NIRMATRELVIR/RITONAVIR (Paxlovid) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, cat's claw may decrease the levels of nirmatrelvir.  Details Cat's claw contains rhynchophylline. Animal research suggests that this alkaloid induces CYP3A expression, thereby accelerating the metabolism of nirmatrelvir, the active component in the nirmatrelvir/ritonavir combination product (115308). This interaction has not been reported in humans.

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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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General ...Orally, cat's claw seems to be well tolerated. Topically, no adverse effects have been reported; however, a thorough safety evaluation has not been conducted.
Serious Adverse Effects (Rare):
Orally: Kidney injury.

Dermatologic ...Orally, itchy skin lesions occurred rarely in one clinical study. As the patients in this study had solid tumors with no further therapeutic options, it cannot be determined if any adverse effects were due to the course of disease or to cat's claw. No placebo was used in the study (92502).

Gastrointestinal ...Orally, cat's claw has been reported to cause nausea, vomiting, abdominal pain, abdominal distention, constipation, epigastric pain, and diarrhea in 2% to 10% of individuals in one clinical study. As the patients in this study had solid tumors with no further therapeutic options, it cannot be determined if any adverse effects were due to the course of disease or to cat's claw. No placebo was used in the study (92502).

Hematologic ...In one clinical study of oral cat's claw, anemia occurred in 12% of patients and leukopenia and thrombocytopenia each occurred in 2% of patients. As the patients in this study had solid tumors with no further therapeutic options, it cannot be determined if any adverse effects were due to the course of disease or to cat's claw. No placebo was used in the study (92502).

Neurologic/CNS ...In one clinical study of oral cat's claw, headache occurred in 2% of patients, fatigue and insomnia each occurred in 4% of patients, and neuropathy occurred in 8% of patients. As the patients in this study had solid tumors with no further therapeutic options, it cannot be determined if any adverse effects were due to the course of disease or to cat's claw. No placebo was used in the study (92502).

Renal ...Several case reports link cat's claw to kidney injury. A patient with systemic lupus erythematosus developed acute kidney failure after taking cat's claw, which improved upon its discontinuation (40279). Another patient with a history of cancer who consumed keto-diet shakes containing cat's claw developed biopsy-confirmed acute interstitial nephritis requiring treatment with prednisone. The patient's serum creatinine normalized three months later after stopping the shake (111737). A separate case cited nephrolithiasis linked to a product containing cat's claw (Digestive Advantage and FlexProtex), likely due to its excipient silica dioxide. The patient's symptoms were reduced after discontinuation (40244).
A clinical study also reported a mild serum creatinine increase in 6% of patients taking oral cat's claw, but causality remains unclear due to the advanced disease states of the participants. No placebo was used in the study (92502).

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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 (11809,11810,113005).

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).

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