Green & Roasted Yerba Mate leaf • Ginger rhizome • Lemon peel • natural Lemon flavor • Stevia leaf.
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Below is general information about the effectiveness of the known ingredients contained in the product Mucho Mate. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
INSUFFICIENT RELIABLE EVIDENCE to RATE
INSUFFICIENT RELIABLE EVIDENCE to RATE
INSUFFICIENT RELIABLE EVIDENCE to RATE
INSUFFICIENT RELIABLE EVIDENCE to RATE
Below is general information about the safety of the known ingredients contained in the product Mucho Mate. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
LIKELY SAFE ...when used orally and appropriately. Ginger has been safely used in multiple clinical trials (721,722,723,5343,7048,7084,7085,7400,7623,11346)(12472,13080,13237,13244,17369,17928,17929,89889,89890,89894)(89895,89898,89899,90102,96252,96253,96259,96260,96669) (101760,101761,101762,103359,107903).
POSSIBLY SAFE ...when used topically and appropriately, short-term (89893,89897).
CHILDREN: LIKELY SAFE
when consumed in the amounts typically found in foods.
CHILDREN: POSSIBLY SAFE
when used orally and appropriately, short-term.
Ginger powder has been used with apparent safety at a dose of up to 750 mg daily for 4 days in girls aged 14-18 years (96255).
PREGNANCY: LIKELY SAFE
when consumed in the amounts typically found in foods.
Ginger is considered a first-line nonpharmacological treatment option for nausea in pregnancy by the American College of Obstetrics and Gynecology (ACOG) (111601). However, it should not be used long-term or without medical supervision and close monitoring.
PREGNANCY: POSSIBLY SAFE
when used for medicinal purposes.
Despite some early reports of adverse effects (721,7083) and one observational study suggesting that taking dried ginger and other herbal supplements during the first 20 weeks of pregnancy marginally increased the chance of stillbirth (96254), most research shows that ginger is unlikely to cause harm to the baby. The risk for major malformations in infants of parents who took ginger when pregnant does not appear to be higher than the baseline rate of 1% to 3% (721,1922,5343,11346,13071,13080,96254). Also, other research suggests that ginger intake during various trimesters does not significantly affect the risk of spontaneous abortion, congenital malformations, stillbirth, perinatal death, preterm birth, low birth weight, or low Apgar scores (18211,90103). Ginger use has been associated with an increase in non-severe vaginal bleeding, including spotting, after week 17 of pregnancy (18211).
LACTATION: LIKELY SAFE
when consumed in the amounts typically found in foods.
There is insufficient reliable information available about the safety of ginger when used for medicinal purposes; avoid amounts greater than those found in foods.
LIKELY SAFE ...when used in amounts commonly found in foods. Lemon has Generally Recognized as Safe (GRAS) status in the US (4912).
POSSIBLY SAFE ...when inhaled in amounts used for aromatherapy, short-term. Lemon essential oil has been used with apparent safety as aromatherapy for up to 2 weeks in clinical research (93475,98128,98129). There is insufficient reliable information available about the safety of lemon when used topically, or when used orally or intranasally in medicinal amounts.
PREGNANCY AND LACTATION:
Insufficient reliable information available.
Avoid using in amounts greater than those typically found in foods.
LIKELY SAFE ...when certain stevia constituents, including stevioside and rebaudiosides A, D, and M, are used orally as sweeteners in foods. These constituents have generally recognized as safe (GRAS) status in the US for this purpose (16699,16700,16702,16705,16706,108049). The stevia constituent stevioside has been safely used in doses of up to 1500 mg daily for 2 years (11809,11810,11811). There is insufficient reliable information available about the safety of whole stevia or stevia extracts when used orally. The European Food Safety Authority (EFSA) has determined that the acceptable intake of steviol glycosides is 4 mg/kg daily (106456); however, it is unclear how this relates to the use of whole stevia or stevia extract.
PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.
POSSIBLY SAFE ...when used orally and appropriately, short-term (11866). Yerba mate has been safely used in doses of 3 grams daily for up to 12 weeks (92152,96469,96470).
POSSIBLY UNSAFE ...when yerba mate is used orally in large amounts or for prolonged periods of time. Drinking approximately 1-2 liters, or 4-8 cups, of yerba mate daily is associated with an increased risk of cancer, including esophageal, stomach, kidney, bladder, cervical, prostate, lung, renal cell, and possibly laryngeal and mouth cancer (1528,1529,1530,1531,11863,11864,92150). Yerba mate also contains caffeine. Acute use of high doses of caffeine (more than 400 mg per day), which is found in more than 8-10 cups of yerba mate, has been associated with significant adverse effects such as tachyarrhythmia and sleep disturbances (11832). Drinking yerba mate in amounts greater than 12-15 cups daily (about 600 mg caffeine) short-term or long-term can also cause caffeinism with symptoms of anxiety possibly progressing to delirium and agitation. Chronic use of caffeine, especially in large amounts, can sometimes produce tolerance, habituation, and psychological dependence (3719). Abrupt discontinuance of caffeine can cause physical withdrawal symptoms (11733). Keep in mind that only the amount of ADDED caffeine must be stated on product labels. The amount of caffeine found in ingredients such as yerba mate, which naturally contains caffeine, does not need to be provided. This can make it difficult to determine the total amount of caffeine in a given product.
CHILDREN: POSSIBLY UNSAFE
when used orally.
Yerba mate is associated with an increased risk of cancer, including esophageal, kidney, bladder, cervical, prostate, lung, and possibly mouth and laryngeal cancer (1528,1529,1530,1531,11863,11864,92150).
PREGNANCY: POSSIBLY UNSAFE
when used orally.
Yerba mate is associated with an increased risk of cancer, including esophageal, kidney, bladder, cervical, prostate, lung, renal cell, and possibly mouth and laryngeal cancer (1528,1529,1530,1531,11863,11864,92150,86595,86614,86700,86701). However, teratogenic studies have not been performed. Yerba mate also contains caffeine. Caffeine crosses the placenta, producing fetal blood concentrations similar to parental levels. According to a review by Health Canada, and a subsequent large meta-analysis conducted in the US, most healthy pregnant patients can safely consume caffeine in doses up to 300 mg daily without an increased risk of spontaneous abortion, stillbirth, preterm birth, fetal growth retardation, or congenital malformations (11733,98806). It is generally recommended to avoid consuming more than 300 mg of caffeine daily, or around 6-7 cups of yerba mate daily, when pregnant (2708). High doses of caffeine throughout pregnancy have resulted in symptoms of caffeine withdrawal in newborn infants (9891,86618). Caffeine in doses of greater than 300 mg daily has also been associated with spontaneous abortion, premature delivery, and low birth weight (2709,2711), although one retrospective study found that consuming yerba mate tea during pregnancy was not associated with preterm or small for gestational age births (13113). However, this study did not consider the amount of yerba mate or caffeine consumed, only the frequency of consumption. Some research has found that intrauterine exposure to even modest amounts of caffeine, based on maternal blood levels during the first trimester, is associated with a shorter stature in children ages 4-8 years (109846).
LACTATION: POSSIBLY UNSAFE
when used orally.
Yerba mate is associated with an increased risk of cancer, including esophageal, kidney, bladder, cervical, prostate, lung, renal cell, and possibly mouth and laryngeal cancer (1528,1529,1530,1531,11863,11864,92150). Whether carcinogenic constituents of yerba mate are transferred via breast milk is unknown. Yerba mate contains caffeine. Consumption of yerba mate might cause irritability and increased bowel activity in nursing infants (6026).
Below is general information about the interactions of the known ingredients contained in the product Mucho Mate. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
Ginger may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs. However, research is conflicting.
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Laboratory research suggests that ginger inhibits thromboxane synthetase and decreases platelet aggregation (7622,12634,20321,20322,20323,96257). However, this has not been demonstrated unequivocally in humans, with mixed results from clinical trials (96257). Theoretically, excessive amounts of ginger might increase the risk of bleeding when used with anticoagulant/antiplatelet drugs.
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Theoretically, taking ginger with antidiabetes drugs might increase the risk of hypoglycemia.
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Theoretically, taking ginger with calcium channel blockers might increase the risk of hypotension.
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Some animal and in vitro research suggests that ginger has hypotensive and calcium channel-blocking effects (12633). Another animal study shows that concomitant administration of ginger and the calcium channel blocker amlodipine leads to greater reductions in blood pressure when compared with amlodipine alone (107901).
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Theoretically, when taken prior to cyclosporine, ginger might decrease cyclosporine levels.
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In an animal model, ginger juice taken 2 hours prior to cyclosporine administration reduced the maximum concentration and area under the curve of cyclosporine by 51% and 40%, respectively. This effect was not observed when ginger juice and cyclosporine were administered at the same time (20401).
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Theoretically, ginger might increase the levels of CYP1A2 substrates.
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In vitro research shows that ginger inhibits CYP1A2 activity (111544). However, this interaction has not been reported in humans.
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Theoretically, ginger might increase the levels of CYP2B6 substrates.
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In vitro research shows that ginger inhibits CYP2B6 activity (111544). However, this interaction has not been reported in humans.
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Theoretically, ginger might increase the levels of CYP2C9 substrates.
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In vitro research shows that ginger inhibits CYP2C9 activity (111544). However, this interaction has not been reported in humans.
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Ginger might increase or decrease the levels of CYP3A4 substrates.
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In vitro research and some case reports suggest that ginger inhibits CYP3A4 activity (111544,111644). Three case reports from the World Health Organization (WHO) adverse drug reaction database describe increased toxicity in patients taking ginger and cancer medications that are CYP3A4 substrates (imatinib, dabrafenib, and crizotinib). However, the causality of this interaction is unclear due to the presence of multiple interacting drugs and routes of administration (111644).
Conversely, other in vitro research suggests that ginger induces CYP3A4 activity, leading to reduced levels of CYP3A4 substrates (111404). However, this interaction has not been reported in humans. |
Theoretically, ginger might increase levels of losartan and the risk of hypotension.
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In animal research, ginger increased the levels and hypotensive effects of a single dose of losartan (102459). It is not clear if ginger alters the concentration or effects of losartan when taken continuously. Additionally, this interaction has not been shown in humans.
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Theoretically, ginger might increase levels of metronidazole.
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In an animal model, ginger increased the absorption and plasma half-life of metronidazole. In addition, the elimination rate and clearance of metronidazole was significantly reduced (20350).
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Ginger may have antiplatelet effects and increase the risk of bleeding if used with nifedipine.
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Clinical research shows that combined treatment with ginger 1 gram plus nifedipine 10 mg significantly inhibits platelet aggregation when compared to nifedipine or ginger alone (20324).
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Ginger might increase the absorption and blood levels of P-glycoprotein (P-gp) substrates.
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In vitro research and case reports suggest that ginger inhibits drug efflux by P-gp, potentially increasing absorption and serum levels of P-gp substrates (111544,111644). Two case reports from the World Health Organization (WHO) adverse drug reaction database describe increased toxicity in patients taking ginger and cancer medications that are P-gp substrates (trametinib, crizotinib). However, the causality of this interaction is unclear due to the presence of multiple interacting drugs and routes of administration (111644).
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Ginger might increase the risk of bleeding with phenprocoumon.
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Phenprocoumon, a warfarin-related anticoagulant, might increase the international normalized ratio (INR) when taken with ginger. There is one case report of a 76-year-old woman with a stable INR on phenprocoumon that increased to greater than 10 when she began consuming dried ginger and ginger tea (12880).
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Ginger might increase the risk of bleeding with warfarin.
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Laboratory research suggests that ginger might inhibit thromboxane synthetase and decrease platelet aggregation (7622,12634,20321,20322,20323). In one case report, ginger increased the INR when taken with phenprocoumon, which has similar pharmacological effects as warfarin (12880). In another case report, ginger increased the INR when taken with a combination of warfarin, hydrochlorothiazide, and acetaminophen (20349). A longitudinal analysis suggests that taking ginger increases the risk of bleeding in patients taking warfarin for at least 4 months (20348). However, research in healthy people suggests that ginger has no effect on INR, or the pharmacokinetics or pharmacodynamics of warfarin (12881,15176). Until more is known, monitor INRs closely in patients taking large amounts of ginger.
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Theoretically, taking itraconazole capsules or tablets with a beverage containing lemon might increase the levels and clinical effects of itraconazole.
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In one case report, dissolving itraconazole tablets in a small amount of specific beverages containing lemon prior to administration increased the level of itraconazole in a lung transplant patient. In this case, the increased bioavailability was desirable and was likely due to improved tablet dissolution in the acidic beverage (110781).
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Theoretically, stevia might increase the risk for hypoglycemia when combined with antidiabetes drugs.
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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).
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Theoretically, combining stevia or stevia constituents with antihypertensive agents might increase the risk of hypotension.
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Theoretically, stevia might decrease clearance and increase levels of lithium.
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Theoretically, the caffeine in yerba mate might decrease the vasodilatory effects of adenosine and interfere with its use prior to stress testing.
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Yerba mate contains caffeine. Some evidence shows that caffeine is a competitive inhibitor of adenosine and can reduce the vasodilatory effects of adenosine in humans (38172). However, other research shows that caffeine does not seem to affect supplemental adenosine because high interstitial levels of adenosine overcome the antagonistic effects of caffeine (11771). Still, some researchers recommend that methylxanthines, such as caffeine, as well as methylxanthine-containing products, should be stopped 24 hours prior to pharmacological stress tests (11770). However, methylxanthines appear more likely to interfere with dipyridamole (Persantine) than adenosine-induced stress testing (11771).
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Theoretically, concomitant use of alcohol and yerba mate might increase levels and adverse effects of the caffeine in yerba mate.
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Theoretically, the caffeine in yerba mate may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
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Theoretically, taking yerba mate with antidiabetes drugs might interfere with blood glucose control.
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Theoretically, the caffeine in yerba mate might reduce the efficacy of benzodiazepines.
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Theoretically, the caffeine in yerba mate might increase the cardiac inotropic effects of beta-agonists, especially if taken in large amounts.
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Yerba mate contains caffeine. Caffeine can increase cardiac inotropic effects of beta-agonists (15).
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Theoretically, the caffeine in yerba mate might reduce the effects of carbamazepine and increase the risk for convulsions.
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Yerba mate contains caffeine. Animal research suggests that caffeine can lower the anticonvulsant effects of carbamazepine and can induce seizures when taken in doses above 400 mg/kg (23561). Human research has shown that taking caffeine 300 mg in three divided doses along with carbamazepine 200 mg reduces the bioavailability of carbamazepine by 32% and prolongs the plasma half-life of carbamazepine two-fold in healthy individuals (23562).
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Theoretically, cimetidine might increase the levels and adverse effects of the caffeine contained in yerba mate.
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Theoretically, the caffeine in yerba mate might increase the levels and adverse effects of clozapine and acutely exacerbate psychotic symptoms.
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Yerba mate contains caffeine. Caffeine might increase the effects and toxicity of clozapine. Caffeine doses of 400-1000 mg per day inhibit clozapine metabolism (5051). Clozapine is metabolized by cytochrome P450 1A2 (CYP1A2). Although researchers speculate that caffeine might inhibit CYP1A2, there is no reliable evidence that caffeine affects CYP1A2. There is also speculation that genetic factors might make some patients more sensitive to an interaction between clozapine and caffeine (13741).
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Theoretically, contraceptive drugs might increase the levels and adverse effects of the caffeine contained in yerba mate.
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Theoretically, concomitant use of CYP1A2 inhibitors and yerba mate might increase levels and adverse effects of the caffeine in yerba mate.
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Theoretically, yerba mate might increase the levels and clinical effects of CYP3A4 substrates.
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In vitro research shows that yerba mate extract inhibits CYP3A4 enzymes (105811). Theoretically, taking yerba mate may increase levels and adverse effects of CYP3A4 substrates.
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Theoretically, the caffeine in yerba mate might decrease the vasodilatory effects of dipyridamole and interfere with its use prior to stress testing.
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Yerba mate contains caffeine. Caffeine inhibits dipyridamole-induced vasodilation (11770,11772). Still, some researchers recommend that methylxanthines, such as caffeine, as well as methylxanthine-containing products, should be stopped 24 hours prior to pharmacological stress (11770). Methylxanthines appear more likely to interfere with dipyridamole (Persantine) than adenosine-induced stress testing (11771).
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Theoretically, disulfiram might increase the levels and adverse effects of the caffeine in yerba mate.
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Theoretically, the caffeine in yerba mate might increase the risk of hypokalemia when used concomitantly with other diuretics.
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Theoretically, the caffeine in yerba mate might increase the risk for stimulant adverse effects when used concomitantly with ephedrine.
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Use of ephedrine with caffeine can increase the risk of stimulatory adverse effects. There is evidence that using ephedrine with caffeine might increase the risk of serious life-threatening or debilitating adverse effects such as hypertension, myocardial infarction, stroke, seizures, and death (1275,6486,10307).
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Theoretically, estrogens might increase the levels and adverse effects of the caffeine in yerba mate.
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Yerba mate contains caffeine. Estrogen inhibits caffeine metabolism (2714).
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Theoretically, the caffeine in yerba mate might reduce the effects of ethosuximide and increase the risk for convulsion.
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Yerba mate contains caffeine. Animal research shows that caffeine 92.4 mg/kg can decrease the anticonvulsant activity of ethosuximide (23560). However, this effect has not been reported in humans.
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Theoretically, the caffeine in yerba mate might reduce the effects of felbamate and increase the risk for convulsion.
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Yerba mate contains caffeine. Animal research shows that a high dose of caffeine 161.7 mg/kg can decreases the anticonvulsant activity of felbamate (23563). However, this effect has not been reported in humans.
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Theoretically, fluconazole might increase the levels and adverse effects of the caffeine in yerba mate.
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Theoretically, the caffeine in yerba mate might increase the levels and adverse effects of flutamide.
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Yerba mate contains caffeine. In vitro evidence suggests that caffeine can inhibit the metabolism of flutamide (23553). However, this effect has not been reported in humans.
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Theoretically, fluvoxamine might increase the levels and adverse effects of the caffeine in yerba mate.
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Theoretically, abrupt withdrawal of the caffeine in yerba mate might increase serum lithium levels.
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Theoretically, metformin might increase the levels and adverse effects of the caffeine in yerba mate.
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Yerba mate contains caffeine. Animal research suggests that metformin can reduce caffeine metabolism (23571). However, this effect has not been reported in humans.
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Theoretically, methoxsalen might increase the levels and adverse effects of the caffeine in yerba mate.
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Yerba mate contains caffeine. Methoxsalen reduces caffeine metabolism (23572).
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Theoretically, mexiletine might increase the levels and adverse effects of the caffeine in yerba mate.
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Theoretically, use of yerba mate with midazolam might increase midazolam metabolite levels and adverse effects.
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In vitro research shows that yerba mate extract containing 6.75% chlorogenic acid significantly inhibits the metabolism of midazolam via inhibition of cytochrome P450 3A4 (CYP3A4)(105811).
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Theoretically, the caffeine in yerba mate might increase risk of a hypertensive crisis when used concomitantly with MAOIs.
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Yerba mate contains caffeine. Caffeine has been shown to inhibit monoamine oxidase (MAO) A and B in laboratory studies (37724,37877,37912,38108). Concomitant intake of large amounts of caffeine with MAOIs might precipitate a hypertensive crisis (15). In a case report, a patient that consumed 10-12 cups of caffeinated coffee and took the MAOI tranylcypromine presented with severe hypertension (91086). Hypertension was resolved after the patient switched to drinking decaffeinated coffee.
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Theoretically, the caffeine in yerba mate might increase risk of hypertension when used concomitantly with nicotine.
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Theoretically, the caffeine in yerba mate might decrease the effects of pentobarbital.
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The caffeine in yerba mate might negate the hypnotic effects of pentobarbital (13742).
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Theoretically, the caffeine in yerba mate might reduce the effects of phenobarbital and increase the risk for convulsions.
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Theoretically, phenylpropanolamine might increase the risk of hypertension as well as the levels and adverse effects of the caffeine in yerba mate.
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Theoretically, the caffeine in yerba mate might reduce the effects of phenytoin and increase the risk for convulsions.
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Yerba mate contains caffeine. Animal research suggests that caffeine can decrease the anticonvulsant activity of phenytoin (23561). The effect does not seem to be related to the seizure threshold-lowering effects of caffeine. However, the exact mechanism of this interaction is unclear.
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Theoretically, the caffeine in yerba mate might increase the levels and clinical effects of pioglitazone.
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Yerba mate contains caffeine. Animal research suggests that caffeine can modestly increase the maximum concentration, area under the curve, and half-life of pioglitazone, and also reduce its clearance. This increased the antidiabetic effects of pioglitazone (108812). However, the exact mechanism of this interaction is unclear.
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Theoretically, quinolone antibiotics might increase the levels and adverse effects of the caffeine in yerba mate.
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Theoretically, concomitant use of riluzole and yerba mate might increase levels and adverse effects of both riluzole and the caffeine in yerba mate.
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Yerba mate contains caffeine. Caffeine and riluzole are both metabolized by cytochrome P450 1A2 (CYP1A2), and concomitant use might reduce the metabolism of one or both agents (11739).
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Theoretically, concomitant use of stimulant drugs and yerba mate might increase stimulant adverse effects.
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Yerba mate contains caffeine. Due to the CNS stimulant effects of the caffeine, concomitant use can increase the risk of adverse effects (11832).
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Theoretically, terbinafine might increase the levels and adverse effects of the caffeine in yerba mate.
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Yerba mate contains caffeine. Terbinafine decreases the rate of caffeine clearance by 19% (11740).
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Theoretically, the caffeine in yerba mate might increase the levels and adverse effects of theophylline.
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Yerba mate contains caffeine. Caffeine decreases theophylline clearance by 23% to 29% (11741).
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Theoretically, the caffeine in yerba mate might increase the levels and adverse effects of tiagabine.
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Yerba mate contains caffeine. Animal research suggests that chronic caffeine administration can increase the serum concentrations of tiagabine. However, concomitant use does not seem to reduce the antiepileptic effects of tiagabine (23561).
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Theoretically, ticlopidine might increase the levels and adverse effects of the caffeine in yerba mate.
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Yerba mate contains caffeine. In vitro research shows that ticlopidine can inhibit caffeine metabolism (23557). However, this effect has not been reported in humans.
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Theoretically, the caffeine in yerba mate might reduce the effects of valproate and increase the risk for convulsions.
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Theoretically, verapamil might increase the levels and adverse effects of the caffeine in yerba mate.
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Yerba mate contains caffeine. Verapamil increases plasma caffeine concentrations by 25% (11741).
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Below is general information about the adverse effects of the known ingredients contained in the product Mucho Mate. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
General
...Orally, ginger is generally well tolerated.
However, higher doses of 5 grams per day increase the risk of side effects and reduce tolerability. Topically, ginger seems to be well tolerated.
Most Common Adverse Effects:
Orally: Abdominal discomfort, burping, diarrhea, heartburn, and a pepper-like irritant effect in the mouth and throat. However, some of these mild symptoms may be reduced by ingesting encapsulated ginger in place of powdered ginger.
Topically: Dermatitis in sensitive individuals.
Cardiovascular ...Orally, use of ginger resulted in mild arrhythmia in one patient in a clinical trial (16306).
Dermatologic
...Orally, ginger can cause hives (17933), as well as bruising and flushing (20316) or rash (20316).
Topically, ginger can cause dermatitis in sensitive individuals (12635,46902).
Gastrointestinal
...Orally, common side effects of ginger include nausea (17933,22602,89898,101761), belching (10380,103359), dry mouth (103359), dry retching (10380), vomiting (10380), burning sensation (10380), oral numbness (22602), abdominal discomfort (5343,89898,96253), heartburn (5343,7624,12472,16306,20316,51845,89894,89895,89898,89899)(101760,101761,101762,111543), diarrhea (5343,101760), constipation (89898,101760,101761), or a transient burning or "chilly hot" sensation of the tongue and throat (52076).
Orally, Number Ten, a specific product composed of rhubarb, ginger, astragalus, red sage, and turmeric, can increase the incidence of loose stools (20346).
Four cases of small bowel obstruction due to ginger bolus have been reported following the ingestion of raw ginger without sufficient mastication (chewing). In each case, the bolus was removed by enterotomy. Ginger is composed of cellulose and therefore is resistant to digestion. It can absorb water, which may cause it to swell and become lodged in narrow areas of the digestive tract (52115).
Genitourinary ...In one clinical trial, some patients reported increased menstrual bleeding while taking a specific ginger extract (Zintoma, Goldaru) 250 mg four times daily orally for 3 days (17931). An "intense" urge to urinate after 30 minutes was reported in two of eight patients given 0.5-1 gram of ginger (7624). However, this effect has not been corroborated elsewhere. Dysuria, flank pain, perineal pain, and urinary stream interruption have been reported in a 43-year-old male who drank ginger tea, containing 2-3 teaspoons of dry ginger, daily over 15 years. The adverse effects persisted for 4 years and were not associated with increases in urinary frequency or urgency. Upon discontinuing ginger, the patient's symptoms began to improve within one week and completely resolved after eight weeks, with no relapses six months later (107902).
Immunologic ...In one case report, a 59-year-old Japanese female with multiple allergic sensitivities developed pruritus and then anaphylactic shock after taking an oral ginger-containing herbal supplement for motion sickness (Keimei Gashinsan, Keimeido). The patient had used this supplement previously for over 20 years with no allergic reaction. The authors theorized the development of a cross-reactivity to ginger after the use of an oral supplement containing zedoary and turmeric, which are also in the Zingiberaceae family (102463).
Neurologic/CNS ...Orally, ginger may cause sedation, drowsiness, or dizziness (16306,17933,51845).
General
...Orally, lemon is well tolerated in amounts commonly found in foods.
A thorough evaluation of safety outcomes has not been conducted on the use of larger amounts.
Most Common Adverse Effects:
Orally: Epigastralgia and heartburn with the regular consumption of fresh lemon juice.
Dermatologic ...Topically, the application of lemon oil might cause photosensitivity, due to furocoumarin derivative content. This occurs most often in fair-skinned people (11019).
Gastrointestinal ...Orally, fresh lemon juice, taken as 60 mL twice daily, has been reported to cause gastrointestinal disturbances in 37% of patients in one clinical trial, compared with 8% of patients in the placebo group. Specifically, of the patients consuming lemon juice, 21% experienced heartburn and 8% experienced epigastralgia, compared to 1% and 3%, respectively, in the placebo group (107489).
General
...Orally, stevia and steviol glycosides appear to be well tolerated.
Most minor adverse effects seem to resolve after the first week of use.
Most Common Adverse Effects:
Abdominal bloating, dizziness, headache, myalgia, nausea, and numbness.
Serious Adverse Effects (Rare):
Allergic reactions.
Gastrointestinal ...Orally, stevia and steviol glycosides such as stevioside, can cause gastrointestinal adverse effects such as abdominal fullness and nausea. However, these generally resolve after the first week of use (11809,11810).
Immunologic ...Theoretically, stevia might cause allergic reactions in individuals sensitive to plants in the Asteraceae/Compositae family (11811). Members of this family include ragweed, chrysanthemums, marigolds, daisies, and many other herbs.
Musculoskeletal ...Orally, stevia and steviol glycosides may cause myalgia, but this generally resolves after the first week of use (11809,11810).
Neurologic/CNS ...Orally, stevia and steviol glycosides may cause headache, dizziness, and numbness (11809,11810).
General
...When used orally in high doses or long-term, yerba mate may be unsafe.
Most Common Adverse Effects:
Orally: Many of the adverse effects of yerba mate can be attributed to its caffeine content, such as diuresis, gastric irritation, insomnia, nausea, nervousness, restlessness, tachycardia, tachypnea, and tremors.
Serious Adverse Effects (Rare):
Orally: Cancer, hyperglycemia, ketosis, metabolic acidosis, sinus tachycardia. These adverse effects are more common with high doses or long-term use.
Cardiovascular
...Orally, yerba mate may cause cardiovascular-related adverse effects due to its caffeine content.
High doses of mate providing 250 mg of caffeine can increase blood pressure. However, this doesn't seem to occur in people who habitually consume caffeine products (2722). Also, epidemiological research suggests that there is no association of caffeine consumption with incidence of hypertension (13739).
Due to its caffeine content, yerba mate may cause other adverse cardiovascular effects when used orally. These effects include tachycardia, quickened respiration, chest pain, premature heartbeat, arrhythmia, and hypertension (11832,11838,13735). Large doses of caffeine can also cause massive catecholamine release and subsequent sinus tachycardia (13734). There is also one report of venous occlusive disease associated with excessive, long-term mate consumption (5614).
Epidemiological research has found that regular caffeine intake of up to 400 mg per day, or approximately 8-10 cups of yerba mate, is not associated with an increased incidence of atrial fibrillation (38018,38076,91028,91034,97451,97453), atherosclerosis (38033), cardiac ectopy (91127), stroke (37804), ventricular arrhythmia (95948,97453), and cardiovascular disease in general (37805,98806).
Combining caffeine beverages such as yerba mate with ephedra may theoretically increase the risk of adverse cardiovascular events. There is one report of ischemic stroke in an athlete who consumed ephedra 40-60 mg, creatine monohydrate 6 grams, caffeine 400-600 mg, and a variety of other supplements daily for six weeks (1275).
Endocrine ...Yerba mate contains caffeine. Orally, large doses of caffeine can cause massive catecholamine release and subsequent metabolic acidosis, hyperglycemia, and ketosis (13734). Some evidence shows caffeine is associated with fibrocystic breast disease, breast cancer, and endometriosis in females. However, this is controversial since findings are conflicting (8043). Restricting caffeine in females with fibrocystic breast conditions doesn't seem to affect breast nodularity, swelling, or pain (8996). A population analysis of the Women's Health Initiative observational study has found no association between consumption of caffeine-containing beverages and the incidence of invasive breast cancer in models adjusted for demographic, lifestyle, and reproductive factors (108806). Also, a dose-response analysis of 2 low-quality observational studies has found that high consumption of caffeine is not associated with an increased risk of breast cancer (108807).
Gastrointestinal ...Orally, drinking yerba mate infusions has been associated with nausea and irritation of the stomach or oral mucosa in a small number of patients in one clinical study (86657). Yerba mate contains caffeine. Orally, caffeine can cause gastric irritation, nausea, and vomiting (11832,11838,13735). Caffeine-containing beverages can stimulate gastric secretion in humans, which may potentiate ulcer symptoms (36404). Some believe that long-term use of caffeine can cause withdrawal symptoms following discontinuation of use. However, the existence of caffeine withdrawal is controversial. Some researchers think that if it exists, it appears to be of little clinical significance (2723,11839). Gastrointestinal withdrawal symptoms such as nausea and vomiting have been described. However, these symptoms may be from nonpharmacological factors related to knowledge and expectation of effects. Clinically significant gastrointestinal symptoms caused by caffeine withdrawal may be uncommon (2723,11839).
Hematologic ...Yerba mate contains caffeine. Orally, caffeine can cause hypokalemia (11832,11838,13735).
Immunologic ...Yerba mate contains caffeine. Orally, caffeine can cause anaphylaxis in sensitive individuals, although true IgE-mediated caffeine allergy seems to be relatively rare (11315).
Musculoskeletal
...Yerba mate contains caffeine.
Some epidemiological research suggests that caffeine may be associated with an increased risk of osteoporosis, but conflicting evidence exists. Caffeine can increase urinary excretion of calcium (2669,10202,11317). Females identified with a genetic variant of the vitamin D receptor appear to be at an increased risk for the detrimental effect of caffeine on bone mass (2669). However, moderate caffeine intake of less than 400 mg per day, or approximately 8-10 cups of yerba mate, does not seem to significantly increase osteoporosis risk in most postmenopausal adults with normal calcium intake (2669,6025,10202,11317,98806).
Some researchers believe that stopping regular use of caffeine may cause withdrawal symptoms such as muscle tension and muscle pains. However, these symptoms may be from nonpharmacological factors related to knowledge and expectation of effects (2723,11839). However, there is a case of withdrawal in a premature neonate following chronic parental drinking of yerba mate (86618). Symptoms included hypertonia in the limbs and brisk tendon reflexes. The authors indicated that high concentrations of caffeine and theobromine were found in the placenta, cord serum, neonatal urine, parental and neonatal hair, meconium, and breast milk. Although symptoms progressively disappeared at 84 hours of age, irritability was still occasionally present at discharge (24 days of age).
Neurologic/CNS
...Orally, drinking yerba mate infusions has been associated with insomnia in a small number of patients in one clinical study (86657).
Yerba mate contains caffeine. Orally, caffeine can cause insomnia, nervousness, headache, anxiety, agitation, jitteriness, restlessness, ringing in the ears, tremors, delirium, and convulsions (11832,11838,13735). Caffeine may also exacerbate sleep disturbances in patients with acquired immunodeficiency syndrome (AIDS) (10204).
There is some concern that stopping regular use of caffeine may cause withdrawal symptoms such as headache, tiredness and fatigue, decreased energy, alertness, and attentiveness, drowsiness, decreased contentedness, depressed mood, difficulty concentrating, irritability, and lack of clear-headedness are typical of caffeine withdrawal (13738). Other symptoms such as delirium, nervousness, restlessness, and anxiety have been described. However, these symptoms may be from nonpharmacological factors related to knowledge and expectation of effects (2723,11839). However, there is a case of withdrawal in a premature neonate following chronic parental drinking of yerba mate (86618). Symptoms included jitteriness and irritability and a high-pitched cry. The authors indicated that high concentrations of caffeine and theobromine were found in the placenta, cord serum, neonatal urine, parental and neonatal hair, meconium, and breast milk. Although symptoms progressively disappeared at 84 hours of age, irritability was still occasionally present at discharge (24 days of age).
Oncologic ...Orally, the prolonged use of yerba mate or use of yerba mate in high doses (typically more than 1-2 liters daily) is associated with an increased risk of cancer, including mouth, esophageal, laryngeal, kidney, bladder, cervical, prostate, and lung cancer (1528,1529,1530,1531,11863,11864,92150,86595,86614,86700,86701). The effect seems to be cumulative and dose dependent. The risk of cancer with yerba mate use seems to increase if it is taken as a warm beverage. In 1991, the International Agency for Research on Cancer (IARC), reported that hot yerba mate drinking is a 2A agent, meaning it is probably carcinogenic for humans (92150). A statement published in 2016 stated there is no conclusive evidence for carcinogenicity when yerba mate is consumed at temperatures that are "not very hot" (95015). Drinking very hot beverages is believed to be a probable cause of esophageal cancer in humans (95015). Concomitant tobacco and alcohol use can increase risk 7-fold (11863).
Pulmonary/Respiratory ...Yerba mate contains caffeine. Orally, caffeine may cause tachypnea-induced respiratory alkalosis (11832,11838,13735). Some researchers think that stopping regular use of caffeine may cause withdrawal symptoms such as runny nose. However, this symptom may be from nonpharmacological factors related to knowledge and expectation of effects (2723,11839).
Renal ...Yerba mate contains caffeine. Orally, caffeine may cause diuresis (11832,11838,13735).