Greens Blend Powdered Drink Mix by Kyo-Green

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.

(Read more about BARLEY)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Dementia. It is unclear if consuming dewaxed brown rice improves cognitive function in adults with dementia. Details: A small clinical study in elderly nursing home residents with low cognitive function shows that eating dewaxed brown rice with 3 meals daily for 6 months improves scores on the Revised Hasegawa's Dementia Scale to a greater extent than eating white rice (103626).
• Diabetes. It is unclear if consuming brown rice as part of the diet is beneficial for improving glycemic control in adults with type 2 diabetes or for prevention of diabetes in healthy adults. Details: Meta-analyses of clinical trials evaluating adults with type 2 diabetes show that consuming a diet containing brown rice 50-450 grams daily for 4-104 weeks does not improve glycated hemoglobin (HbA1c) levels or fasting blood glucose levels when compared with a white rice diet (108661,108662). Clinical trials using non-glutinous brown rice for 24 hours or 16 weeks show similar results (96996,96998). However, not all research agrees. Preliminary clinical research in adults with type 2 diabetes shows that eating glutinous brown rice twice daily for 8 weeks modestly reduces HbA1c levels, compared with no change in those eating white rice (96995). Preliminary clinical research also shows that eating glutinous brown rice as the staple food over a 24-hour period helps with acute glycemic response when compared with white rice (96996). Other preliminary clinical research in females with type 2 diabetes shows that following a brown rice diet for 12 weeks reduces HbA1c and fasting blood glucose by 3% to 5% and reduces body weight and body fat by approximately 2% when compared with no intervention (18660). Clinical trials in adults with type 2 diabetes also report conflicting effects of brown rice on body weight, waist circumference, body fat, lipids, and blood pressure when compared with white rice (108661,108662). However, the limited studies showing positive benefits of brown rice report very minor effects with unclear clinical implications. The reasons for these discrepancies are unclear but may be related to the slight differences between the varieties of brown rice. Additionally, brown rice has been evaluated for prevention of diabetes. A meta-analysis of three cohort studies in healthy adults suggests that a higher consumption of brown rice is associated with a reduced risk of developing type 2 diabetes when compared with lower consumption (115486). The validity of this finding is limited by the inclusion of lower quality studies, reliance on self-reported outcomes, and a largely female population in the observational cohort studies.
• Impaired glucose tolerance (Prediabetes). It is unclear if consuming brown rice as part of the diet is beneficial for improving glycemic control; the available research is conflicting. Details: A meta-analysis of clinical trials evaluating adults with prediabetes shows that consuming a brown rice-based diet for 6-12 weeks does not improve glycated hemoglobin (HbA1c) levels, fasting blood glucose levels, body weight, or waist circumference when compared with a white rice-based diet (108662). However, some preliminary clinical research in middle-aged females with prediabetes shows that replacing staple white rice in the diet with pre-germinated brown rice for 4 months modestly reduces fasting blood glucose and HbA1c levels when compared with baseline. There were also small improvements in body fat, body mass, systolic and diastolic blood pressure, and total cholesterol levels when compared with baseline (96997). The validity of these findings is limited by the lack of a comparator group.
• Metabolic syndrome. It is unclear if consuming brown rice reduces the prevalence of metabolic syndrome or improves metabolic parameters in patients with this condition. Details: Preliminary clinical research in adults with metabolic syndrome shows that eating brown rice ad libitum for 16 weeks does not improve metabolic factors or reduce the number of patients still meeting the diagnosis of metabolic syndrome when compared with eating white rice ad libitum (96998). However, other clinical research shows that eating 200 grams daily of cooked, pre-germinated brown rice for 3 months reduces the number of patients meeting the diagnosis of metabolic syndrome by 30%, compared with a reduction of 10% in those eating 200 grams daily of cooked white rice (103627). This suggests that any benefit might be related to regular consumption of brown rice. A small clinical study in overweight adults with metabolic syndrome shows that eating brown rice with 2 meals per day, 6 days per week for 3 months, reduces glycated hemoglobin (HbA1c) when compared with eating the same amount of white rice (103623). Other preliminary clinical research shows that eating sticky or glutinous brown rice for 8 weeks modestly improves body weight, some measures of insulin resistance, and levels of low-density lipoprotein (LDL) cholesterol when compared with baseline (96999). The validity of these findings is limited by the lack of a comparator group.
• Obesity. Although there is interest in using oral brown rice for weight loss, there is insufficient reliable information about the clinical effects of brown rice for this purpose.
• Psoriasis. Although there is interest in using oral brown rice for psoriasis, there is insufficient reliable information about the clinical effects of brown rice for this condition. More evidence is needed to rate brown rice for these uses.

(Read more about BROWN RICE)

POSSIBLY EFFECTIVE

• Pregnancy-related iron deficiency. Oral chlorella, which contains iron, can help to prevent iron deficiency and anemia in pregnancy. Details: A small clinical study in Japanese patients in their first trimester of pregnancy shows that taking chlorella (Sun Chlorella A, Sun Chlorella Corp.) 2 grams three times daily, providing 7.2 mg iron daily, starting at the 12-18th week of gestation and continuing until delivery, reduces the incidence of maternal anemia, defined as a hemoglobin level less than 11 g/dL, to about 30%, compared with about 60% in patients receiving no intervention (95013).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Brain tumor. It is unclear if oral chlorella is beneficial in patients with glioma. Details: A small clinical study in patients with glioma shows that taking chlorella tablets plus chlorella liquid extract over 2 years might improve tolerability of chemotherapy and radiotherapy, but does not seem to affect tumor progression or survival, when compared to baseline (6804). The validity of this finding is limited by the lack of a comparator group.
• Depression. It is unclear if oral chlorella is beneficial as an adjunct to conventional antidepressant therapy in patients with major depressive disorder. Details: One open-label clinical trial in patients with major depressive disorder shows that taking chlorella extract tablets (ALGOMED, Bioprodukte Prof. Steinberg Produktions-und Vertreibs GmbH & Co.) 600 mg three times daily in addition to standard antidepressant therapy for 6 weeks improves subjective symptoms of depression and anxiety, measured on the Beck Depression Inventory II and the Hospital Anxiety and Depression Scale, when compared with standard antidepressant therapy alone (92132). The validity of this finding is limited by the large number of patients lost to follow-up and a lack of blinding.
• Dysmenorrhea. It is unclear if oral chlorella improves symptoms of dysmenorrhea. Details: A small clinical study in females 18-35 years of age with primary dysmenorrhea shows that taking chlorella (American Super Golden Med) 1500 mg daily for 8 weeks modestly decreases the severity and duration of painful menstrual cramps when compared with placebo (99882). This study is limited by small sample size and unclear allocation concealment.
• Exercise-induced respiratory infections. It is unclear if oral chlorella can prevent respiratory infections related to exercise. Details: A small clinical trial in physically active adults shows that taking chlorella (Sun Chlorella A, Sun Chlorella Corp.) 3 grams twice daily for 6 weeks increases salivary IgA, a marker of immune response, but doesn't improve the duration or severity of upper respiratory symptoms or reduce the risk for upper respiratory tract infections when compared with placebo (99881). However, this study was likely underpowered to detect differences in these outcomes.
• Fatigue. It is unclear if oral chlorella improves fatigue from exercise. Details: A small clinical trial in healthy males shows that taking chlorella (Chlorella Kogyo Co., Ltd) 2 grams three times daily for 4 weeks does not decrease exercise-induced fatigue or fatigue at rest when compared with placebo (99880).
• Fibromyalgia. It is unclear if oral chlorella improves symptoms of fibromyalgia. Details: A small open-label clinical trial in people with fibromyalgia shows that taking chlorella tablets (Sun Chlorella) 10 grams plus a liquid chlorella extract (Wakasa Gold) 100 mL daily for 2 months improves general symptoms and pain scores when compared with baseline (5890). The validity of this finding is limited by the lack of a comparator group.
• Halitosis. Although there is interest in using oral chlorella for halitosis, there is insufficient reliable information about the clinical effects of chlorella for this purpose.
• Hepatitis C. It is unclear if oral chlorella improves outcomes in patients with chronic hepatitis C infection. Details: A small clinical trial in patients with chronic hepatitis C virus (HCV) genotype 1 infection shows that taking chlorella tablets (Sun Chlorella A, Sun Chlorella Corp) 1500 mg twice daily for one week, then 1500 mg three times daily for 11 weeks, in addition to an extract containing 82 mg/mL of chlorella (Wakasa Gold, Sun Chlorella Corp) 30 mL twice daily for 12 weeks, decreases alanine aminotransferase (ALT) levels, but not aspartate aminotransferase (AST) or HCV RNA levels, when compared to baseline (92130). The validity of this finding is limited by the lack of a comparator group.
• Hyperlipidemia. It is unclear if oral chlorella reduces lipid levels. Details: A meta-analysis of mostly low-quality clinical studies in healthy adults and those with metabolic disorders shows that taking chlorella 900-5000 mg daily for 3-8 weeks reduces both total cholesterol and low-density lipoprotein (LDL) cholesterol by about 8 mg/dL but does not reduce triglycerides or increase high-density lipoprotein cholesterol when compared with placebo (113623). Additionally, a small clinical trial in patients with mild hypercholesterolemia, defined as total cholesterol between 200-250 mg/dL, who are not using lipid-lowering medications, suggests that taking chlorella (Daesang Corp.) 1664 mg three times daily for 4 weeks reduces total cholesterol by 1.6% and triglycerides by 10.3%, but does not affect low-density lipoprotein cholesterol or high-density lipoprotein cholesterol, when compared with placebo (92131). This study was limited by its short duration and small size.
• Hypertension. It is unclear if oral chlorella is beneficial in patients with hypertension. Details: Preliminary clinical research in patients with mild to moderate hypertension shows that taking chlorella 10 grams and chlorella extract 100 mL daily for 1-2 months does not reduce blood pressure when compared to baseline (41811).
• Metabolic syndrome. Although there is interest in using oral chlorella for metabolic syndrome, there is insufficient reliable information about the clinical effects of chlorella for this condition.
• Nonalcoholic fatty liver disease (NAFLD). Oral chlorella has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small open-label clinical trial in patients with NAFLD shows that taking chlorella extract 1200 mg with metformin 750 mg and vitamin E 200 mg daily for 3 months decreases alanine aminotransferase (ALT), aspartate aminotransferase (AST), and triglyceride levels when compared to baseline. Treatment with metformin 1250 mg and vitamin E 200 mg daily without chlorella does not appear to improve these outcome measures (99878). This study is limited by the lack of statistical comparison between groups.
• Peptic ulcers. Although there is interest in using oral chlorella for peptic ulcers, there is insufficient reliable information about the clinical effects of chlorella for this purpose.
• Pregnancy-induced hypertension. It is unclear if oral chlorella is beneficial for preventing pregnancy-induced hypertension. Details: A small clinical study in healthy Japanese patients in their first trimester of pregnancy shows that taking chlorella (Sun Chlorella A, Sun Chlorella Corp.) 2 grams three times daily, starting at the 12-18th week of gestation and continuing until delivery, reduces proteinuria and leg edema, but does not affect blood pressure, when compared with no intervention (95013). It is unclear if chlorella is beneficial in patients who are at risk for hypertension during pregnancy.
• Ulcerative colitis. Although there is interest in using oral chlorella for ulcerative colitis, there is insufficient reliable information about the clinical effects of chlorella for this condition. More evidence is needed to rate chlorella for these uses.

(Read more about CHLORELLA)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Constipation. Small clinical studies suggest that oral FOS may modestly improve symptoms in patients with constipation when used in combination with probiotics. The benefits of FOS when used alone are unclear. Details: Most clinical research has evaluated the use of FOS for constipation in conjunction with probiotics. Preliminary clinical research in adults with chronic functional constipation shows that taking an unspecified dose of a specific product (Hexbio) consisting of FOS, Lactobacillus acidophilus, Lacticaseibacillus casei, Lactococcus lactis, Bifidobacterium bifidum, Bifidobacterium longum, and Bifidobacterium infantis orally twice daily for 7 days increases defecation frequency by 3-fold when compared with placebo. Taking this product also improved patient reported symptoms of straining, lumpy hard stools, and incomplete evacuation sensations (90266). Other clinical research in adult females with constipation shows that taking a different product (Lactofos, SKL Functional Nutrition Ltda.) containing FOS 6 grams and Lacticaseibacillus paracasei, Lacticaseibacillus rhamnosus, Lactobacillus acidophilus, and Bifidobacterium lactis 0.1-1 billion colony-forming units each, orally twice daily for 30 days, modestly increases the frequency of evacuation and decreases constipation severity when compared with placebo (90300). It is unclear if these effects are due to FOS, other ingredients, or the combination. In children aged 4-8 years with functional constipation, preliminary clinical research shows that taking a mixture of FOS 0.45 grams and polydextrose 4.17 grams orally daily for 45 days improves the weekly frequency of bowel movements, clinical manifestations of constipation, and quality of stool type when compared with baseline (106482). It is unclear if these effects are due to FOS, polydextrose, or the combination. Additionally, the validity of these findings is limited by the lack of a comparator group. Clinical research evaluating the use of FOS alone is limited. Preliminary clinical research in elderly males shows that taking FOS alone 3-10 grams daily for 30 days increases the frequency of defecation by 1.5-fold when compared with baseline (8505). The validity of this study is limited by the lack of a comparator group. In non-breastfeeding infants 6-24 months of age with constipation, preliminary clinical research shows that fortifying formula or milk with FOS daily for 4 weeks increases the frequency of soft stools by 33% and decreases the frequency of straining by 55% when compared with placebo. However, the use of FOS did not increase the percentage of infants who achieved normal bowel pattern. The daily dose of FOS was 6 grams for infants 6-8.9 kg, 9 grams for infants 9-11.9 kg, and 12 grams for infants over 12 kg (98651).
• Diabetes. Oral FOS has only been evaluated in combination with probiotics; its effect when used alone is unclear. Details: Preliminary clinical research in adults with type 2 diabetes shows that taking a combination product containing FOS 500 mg, Bacillus coagulans 100 billion spores, Lacticaseibacillus rhamnosus 10 billion colony-forming units (CFUs), and Lactobacillus acidophilus 1 billion CFUs once daily for 12 weeks reduces fasting blood glucose by 17 mg/dL, compared with an increase of 3 mg/dL with placebo. However, taking this product did not affect body weight, waist circumference, or cholesterol levels. It is unclear if this effect is due to FOS, other ingredients, or the combination (107731).
• Hematopoietic stem cell transplant (HSCT). It is unclear if oral FOS is beneficial in patients undergoing HSCT. Details: Preliminary clinical research in patients undergoing an allogeneic HSCT shows that taking a specific oral FOS supplement, (Fibrulose F97, Cosucra Groupe) 5-15 grams daily for 21 days, beginning 5 days before transplant, does not reduce acute graft-versus-host disease, blood stream infections, or Clostridioides difficile infections or improve overall survival when compared with control (107931). However, this study may have been inadequately powered to detect a difference between groups.
• Hypercholesterolemia. Although there has been interest in using oral FOS for hypercholesterolemia, there is insufficient reliable information about the clinical effects of FOS for this purpose.
• Obesity. Although there has been interest in using oral FOS for obesity, there is insufficient reliable information about the clinical effects of FOS for this purpose.
• Osteoporosis. Oral FOS has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in postmenopausal adults shows that taking a specific FOS product (NutraFlora, Ingredion Inc.) 3.2 grams plus calcium 800 mg daily for 24 months reduces the decline in total-body bone mineral density (BMD) when compared with calcium alone, but not when compared with a maltodextrin control. In a subgroup of patients with osteopenia, this combination reduced the decline in BMD in the lumbar vertebrae when compared with calcium alone or a maltodextrin control (94931).
• Travelers' diarrhea. It is unclear if oral FOS is beneficial for preventing traveler's' diarrhea. Details: Preliminary clinical research shows that taking FOS 10 grams orally daily for 4 weeks, starting 2 weeks before traveling to a medium- to high-risk destination, does not reduce the incidence of travelers' diarrhea when compared with placebo (10373). However, the study may have been inadequately powered to detect a difference between groups. More evidence is needed to rate FOS for these uses.

(Read more about FRUCTO-OLIGOSACCHARIDES (FOS))

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Benign prostatic hyperplasia (BPH). Although there has been interest in using oral wheatgrass for BPH, there is insufficient reliable information about the clinical effects of wheatgrass for this purpose.
• Beta-thalassemia. It is unclear if oral wheatgrass is beneficial in patients with beta-thalassemia. Details: A small clinical study in children with beta-thalassemia major shows that taking wheatgrass tablets orally in doses of 1-1.5 grams daily for children aged 1-3 years, 3 grams daily for children 4-8 years, and 4 grams daily for children aged 9 years and older for 12 months decreases the mean blood transfused as packed cells by about 18%, increases mean hemoglobin by about 7%, and increases the mean interval between consecutive blood transfusions by about 5 days when compared to baseline (93021). The validity of this study is limited by the lack of a comparator group and high patient dropout rate. However, another small clinical study shows that taking wheatgrass tablets 100 mg/kg orally daily for 6 months followed by 200 mg/kg daily for an additional 6 months does not reduce the transfusion requirement when compared to baseline in children or adults with beta-thalassemia major (93020). The validity of this study is limited by the lack of a comparator group. Another small, low-quality study shows that drinking wheatgrass juice 100 mL daily for 18 months reduces blood transfusion requirements in children with beta-thalassemia major when compared to baseline (85601). The validity of this study is limited by the lack of a comparator group and high patient dropout rate.
• Bronchitis. Although there has been interest in using oral wheatgrass for bronchitis, there is insufficient reliable information about the clinical effects of wheatgrass for this purpose.
• Cancer. Although there has been interest in using oral wheatgrass for cancer, there is insufficient reliable information about the clinical effects of wheatgrass for this purpose.
• Common cold. Although there has been interest in using oral wheatgrass for common cold, there is insufficient reliable information about the clinical effects of wheatgrass for this purpose.
• Cough. Although there has been interest in using oral wheatgrass for cough, there is insufficient reliable information about the clinical effects of wheatgrass for this purpose.
• Diabetes. Although there has been interest in using oral wheatgrass for diabetes, there is insufficient reliable information about the clinical effects of wheatgrass for this purpose.
• Gout. Although there has been interest in using oral wheatgrass for gout, there is insufficient reliable information about the clinical effects of wheatgrass for this purpose.
• Hypercholesterolemia. It is unclear if oral wheatgrass is beneficial in patients with hypercholesterolemia. Details: Preliminary clinical research shows that taking freeze-dried wheatgrass powder 3.5 grams orally daily for 10 weeks reduces total cholesterol by 5% and triglycerides by 10% when compared to baseline in females aged 30-60 years with elevated cholesterol levels. However, taking wheatgrass powder does not reduce low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, or fasting blood glucose levels in these patients (95906).
• Hypertension. Although there has been interest in using oral wheatgrass for hypertension, there is insufficient reliable information about the clinical effects of wheatgrass for this purpose.
• Kidney stones (nephrolithiasis). Although there has been interest in using oral wheatgrass for nephrolithiasis, there is insufficient reliable information about the clinical effects of wheatgrass for this purpose.
• Plantar heel pain. It is unclear if topical wheatgrass is beneficial in patients with plantar heel pain. Details: Preliminary clinical research in adults with chronic plantar fasciitis shows that applying a wheatgrass 10% cream topically to the bottom of the feet twice daily for 6 weeks is no more effective than placebo for reducing pain or improving measures of injury resolution (85602).
• Pharyngitis. Although there has been interest in using oral wheatgrass for pharyngitis, there is insufficient reliable information about the clinical effects of wheatgrass for this purpose.
• Prostatitis. Although there has been interest in using oral wheatgrass for prostatitis, there is insufficient reliable information about the clinical effects of wheatgrass for this purpose.
• Ulcerative colitis. It is unclear if oral wheatgrass is beneficial in patients with ulcerative colitis. Details: A small clinical study in adults with active distal ulcerative colitis shows that drinking 100 mL of freshly extracted wheatgrass juice daily for 1 month modestly reduces overall disease activity and the severity of rectal bleeding when compared with placebo (11165).
• Urinary tract infections (UTIs). Although there has been interest in using oral wheatgrass for UTIs, there is insufficient reliable information about the clinical effects of wheatgrass for this purpose.
• Wound healing. Although there has been interest in using oral wheatgrass for wound healing, there is insufficient reliable information about the clinical effects of wheatgrass for this purpose. More evidence is needed to rate the effectiveness of wheatgrass for these uses.

(Read more about WHEATGRASS)

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.

(Read more about BARLEY)

LIKELY SAFE ...when used orally in amounts commonly found in foods. Brown rice has Generally Recognized as Safe (GRAS) status in the US (7705). There is insufficient reliable information available about the safety of brown rice when used orally in medicinal amounts.

CHILDREN: LIKELY SAFE
when used orally in amounts commonly found in food. Brown rice has Generally Recognized as Safe (GRAS) status in the US (7705). There is insufficient reliable information available about the safety of brown rice when used in medicinal amounts in children.

PREGNANCY AND LACTATION: LIKELY SAFE
when used orally in amounts commonly found in foods (7705). There is insufficient reliable information available about the safety of brown rice when used in medicinal amounts during pregnancy or lactation.

(Read more about BROWN RICE)

LIKELY SAFE ...when used orally and appropriately, short-term. Tablets and liquids containing chlorella 3-10 grams or 60-100 mL daily have been safely used in clinical studies lasting 2-3 months (5890,92130,92131). Also, chlorella extract 200-1800 mg daily has been safely used in clinical research for 4-6 weeks (10388,92132). There is insufficient reliable information available about the safety of chlorella when used topically.

PREGNANCY: POSSIBLY SAFE
when used orally and appropriately in medicinal amounts for up to approximately 28 weeks. A commercially available chlorella supplement (Sun Chlorella A, Sun Chlorella Corp.) has been safely used in doses of 6 grams daily, starting during the 12-18th week of gestation and continuing until delivery (95013).

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about CHLORELLA)

POSSIBLY SAFE ...when used orally and appropriately, alone or in combination with probiotics, in doses up to 30 grams daily for up to 4 weeks (741,745,8505,90266,107729,107931). ...when a specific FOS product (NutraFlora, Ingredion Inc.) is used orally in combination with calcium at doses up to 3.2 grams daily for up to 24 months (94931).

CHILDREN: POSSIBLY SAFE
when short-chain FOS are included in approved infant formulas for healthy term infants at a level of up to 4 grams/L or 1 gram/kg daily (94929,94930,98651).

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

(Read more about FRUCTO-OLIGOSACCHARIDES (FOS))

LIKELY SAFE ...when consumed in amounts commonly found in foods (5286).

POSSIBLY SAFE ...when wheatgrass juice is taken orally and appropriately in medicinal amounts. Wheatgrass juice 60-100 mL daily has been used safely for up to 18 months (11165,85601,104878,104879). ...when wheatgrass cream is used topically. Wheatgrass 10% cream has been used safely for up to 6 weeks (85602). There is insufficient reliable information available about the long-term safety of wheatgrass when used medicinally.

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

(Read more about WHEATGRASS)

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.

(Read more about BARLEY)

(Read more about BROWN RICE)

PHOTOSENSITIZING DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, chlorella might have additive effects with photosensitizing drugs.  Details Chlorella has been reported to cause photosensitization (3900,5852). In five case reports, patients who had ingested chlorella exhibited swelling followed by erythematopurpuric lesions on sun-exposed areas of the body (5852). Theoretically, concomitant use with photosensitizing drugs may exacerbate effects.

WARFARIN (Coumadin) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, chlorella might reduce the clinical effects of warfarin.  Details Chlorella contains significant amounts of vitamin K. There is at least one case report of warfarin therapy becoming sub-therapeutic after initiation of chlorella supplements (3900,41830).

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(Read more about FRUCTO-OLIGOSACCHARIDES (FOS))

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking wheatgrass with antidiabetes drugs might lower blood glucose levels and increase the risk of hypoglycemia.  Details Animal research shows that taking wheatgrass stimulates the release of insulin from beta-cells and lowers blood glucose (93018,93019).

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, wheatgrass might decrease the levels and clinical effects of CYP1A2 substrates.  Details In vitro research shows that wheatgrass induces CYP1A2 enzymes (111404).

(Read more about WHEATGRASS)

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, brown rice is well tolerated when consumed as a food. No adverse effects have been reported when used in medicinal amounts; however, a thorough evaluation of safety outcomes has not been conducted.

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General ...Orally, chlorella is generally well-tolerated.
Most Common Adverse Effects:
Orally: Allergic reactions, abdominal cramping, constipation, diarrhea, fatigue, flatus, nausea, photosensitivity, and stool discoloration.
Serious Adverse Effects (Rare):
Orally: Anaphylaxis.

Dermatologic ...Orally, photosensitivity reactions have occurred following ingestion of chlorella (3900,5852). According to case reports, five patients who had ingested chlorella exhibited swelling followed by erythematopurpuric lesions on sun-exposed areas of the body (5852). The photosensitizing agent in the chlorella tablets was identified as pheophorbide-a and its ester.

Gastrointestinal ...Orally, chlorella can cause diarrhea, abdominal cramping, flatus, and nausea, especially during the first two weeks of treatment (5890,6804,92130,92132). In one clinical trial, one out of 42 patients reported nausea and one reported diarrhea (92132). In another trial, taking chlorella tablets (Sun Chlorella A, Sun Chlorella Corp) and a chlorella extract (Wakasa Gold, Sun Chlorella Corp) resulted in transient worsening of constipation in 4 of 13 patients and transient mild diarrhea in 2 of 13 patients (92130).
Green discoloration of the feces has also been reported, due to the chlorophyll content of chlorella (6804,95013).

Hematologic ...Orally, chlorella has been linked to one case of thrombocytopenia; however, causality has not been determined. A 49-year-old female living in Turkey presented with thrombocytopenia (a platelet count of 27,000/mm³) after taking chlorella 1080 mg daily for 20 days. Platelet counts had been normal one month earlier, and returned to normal two weeks after discontinuing the chlorella supplement (99879).

Immunologic ...Allergic reactions, including asthma and anaphylaxis, have been reported in people taking chlorella and in those preparing chlorella tablets (3900,5847,41827,105645).

Neurologic/CNS ...Orally, manganese (Mn)-induced parkinsonism has been reported after long-term consumption of chlorella extract. In this case, a patient on maintenance hemodialysis reported gait disturbance, dysarthria, elevated serum and cerebrospinal fluid manganese levels, and abnormal magnetic resonance imaging (MRI) findings of the brain. The authors identified the condition as a rare case of Mn-induced parkinsonism, which may have been due to long-term ingestion of a chlorella extract containing 1.7 mg of Mn in the usual daily dose. The patient underwent edetic acid infusion therapy, which improved the MRI abnormalities and the other symptoms improved four months later (41817).
In one study, fatigue was reported in 18 of 41 patients receiving chlorella 200 mg (10388).

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General ...Orally, FOS are generally well tolerated.
Most Common Adverse Effects:
Orally: Abdominal pain, bloating, flatulence.

Gastrointestinal ...Orally, FOS may cause flatulence, belching, abdominal pain, intestinal sounds, constipation, and bloating. These symptoms can occur commonly in some patients, but are generally mild at doses under 10 grams per day (745,750,8509,98651,107931). However, a meta-analysis of 8 small clinical studies shows that taking FOS at doses ranging from 2.5 grams to 15 grams daily for up to 8 weeks does not increase the rate of abdominal pain, bloating, flatulence, or intestinal sounds when compared with control groups (110710).

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General ...Orally, wheatgrass is generally well tolerated.
Most Common Adverse Effects:
Orally: Allergic reactions, anorexia, constipation, nausea.

Gastrointestinal ...Orally, wheatgrass may cause nausea, anorexia, and constipation (11165).

Immunologic ...Wheat can cause allergic reactions in sensitive individuals. Due to the prevalence of this allergy in the general population, wheat and wheat products, such as wheatgrass, are classified as major food allergens in the United States (105410).

(Read more about WHEATGRASS)