Recently there has been an increased interest in the use of Kambo. This interest has made its way into the sporting world. The following YouTube video https://www.youtube.com/watch?v=pEsUtZhnQoE&ab_channel=BBTVBOXING looks at the ceremony, reasons and effects of the “frog medicine” which is believed to have a number of physical and mental health benefits. However a disclaimer is provided which states “(NB this is not an endorsement or medically approved this is just a look at the practice for those who don’t know anything about it)”

In this blog, I discuss the issues surrounding Kambo in sport. It is written to create discussion. I would be interested in your comments.

What is Kambo?

Kambo (or Sapo) is the name of a secretion of the giant leap frog (Phyllomedusa bicolor) from the Amazonian forest. It was used for centuries by local tribes to enhance their “hunting” skills. The effects of Kambo were first described in 1925. These included nausea and vomiting. The use of Kambo has recently been advocated by those involved with alternative medicine and celebrities as a ‘healing’ intervention to cleanse the bodily systems [1].

Currently, only 16 known bioactive peptides have been isolated from Kambe. These include Adenoregulin, bombesin, bombesinnona peptide, dermorphine, caerulein, deltorphin, neurokinin B, phyllomedusin, phyllocaerulein, phyllokinin, phyllolitorin, preprotachykinin B, ranatachykinin A, sauvagine, T-kinin and urechistachykinin II [2]. There are many more as yet unknown compounds to be isolated.

The compounds described as enhancing stamina and better hunting skills may be a result of the opioid effects of dermorphine and caerulin. These compounds are reported to be 40 times more potent than morphine [3].

How is Kambo used today?

Kambo is used in a specific neo-shamanic subculture as a healing- intervention and as a method to “detox” the body [4]. A practitioner will use a burning vine to create a number of small burns on the skin, resulting in blisters. The blistered skin is then scraped off, and the Kambo is applied to the wounds. For more information see this website for sessions provided in East Sussex https://www.kambofrog.co.uk/

Although Hesselink [1] suggests starting with a small dose to assess for individual sensitivity – as higher doses may lead to severe adverse effects, there is no published evidenced based data on the dosing of Kamba. Also, and an important consideration, is the experience of the practitioner administrating Kambo. I am not aware of a certified and nationally recognised register of practitioners in administrating Kambo.

Apparently, there is a closed Facebook group where around 6000 participants are registered. Based on previous case reports, Kambo should not be used in those with cardiovascular conditions, psychosis, severe depression, bipolar disorders, severe anxiety, epilepsy, addison’s disease, low blood pressure, history of aneurisms, pregnancy, and children [1,5]. Hydration is an important consideration, however drinking too much water may result in the body retaining too much water due to the hormonal effects of Kamba (Syndrome of Inappropriate Anti-Diuretic Hormone secretion). This may cause cerebral oedema (increased fluid around the brain).

Adverse reactions of Kambo

These include nausea, vomiting, diarrhoea, abdominal pain, dizziness, palpitations, anaphylaxis, loss of bladder control, dehydration, muscle spasms and cramps, convulsions, jaundice, anxiety, and skin scarring [1,2,5].

Interestingly, Kambo is used by the Giant Leaf Frog to produce a “molecular electric shock” in a predator’s mouth, so it is quickly ejected. The poison works by overloading the predator’s internal system with chemicals, prompting regurgitation, muscle spasms, vomiting, and intestinal convulsion—hence the sick buckets at Kambo ceremonies [6]. Due to the neurochemical action of Kambo there could be an addictive nature to this drug – especially in view of the opioid effects. Anecdotal evidence suggests that individuals who use Kambo in the UK describe the desire for repeated use. Practitioners are keen to stress that dosing should be restricted to 12 times a year [6]. However, there is no substantiation of this claim.

Use of Kambo in athletes

While there has been a lot of anecdotal data on the use of Kambo, there is no scientific evidence-based research on the dosing of Kamba. Although some adverse effects are known (described above), we truly do not know the pharmacological effects of Kambo. Additionally, unlike registered practitioners in medicine, nursing etc, there is not (as far as I know) a legal governing regulatory body that oversees practitioners who administers Kamba. However, in the UK, there are a growing number of people conducting Kambo ceremonies, either trained in the Amazon or by the International Association of Kambo Practitioners (IAKP), which administers, teaches, and regulates the use of Kambo (https://iakp.org/). The IAKP already has 13 registered practitioners in the UK and more than 50 worldwide [7]. There are various websites that offer training (https://www.kambo-dots.co.uk/). However, I am unclear of what is involved in terms of regulating practitioners. This anecdote does not provide any confidence https://www.dailymail.co.uk/news/article-6817737/Woman-dies-alternative-kambo-ceremony-gave-heart-attack.html

We are all too aware of the hydration issues of athletes involved with boxing, especially on the run-up to an event. Considering the effects of Kambo on fluid-balance, this is something to be aware of. Athletes could end up having muscle spasms, palpitations and convulsions. However, on the other hand, the advice is that individuals should not drink too much because of the risk of a hormonal imbalance that can cause fluid retention (SIADH – described earlier). I therefore think that this agent should not be permitted in the sporting arena.

Another issue is related to the psychoactive nature of the bioactive peptides associated with Kambo. The IAKP denies it, but Kambo does, technically, have psychoactive properties. Kambo contains opioid peptides such as dermorphin, dermenkephalin, and the deltorphins, which are ingested via the burn points. These are potent opioid receptor agonists in the central nervous system, which by definition will affect the mental state of the individual. It is therefore not correct to state that these drugs aren’t psychoactive. Considering this, should athletes be using this agent?

On another note, we are all aware of the World Anti-Doping Code [7] with regards the use of narcotics and hormones. Although Kambo is not on this list, could some of the ingredients be considered prohibited under the umbrella of “All natural and synthetic….” (concerning stimulants and hormonal agents) or, in reference to narcotics “All optical isomers….”, or “all agents administered exogenously, but not limited to…” I am not an expert in this area, but considering what I have read, I do not think Kambo would be a permitted substance. This, needs clarifying. This substance could be considered in similar vain to the issues and legalities surrounding cannabinoids.

Finally, I am not clear of the legality of Kambo in the UK. What do we advise an athlete who used Kambo? My feeling is that it should not be used, especially as we do not know about the agent in terms of its dosing, pharmacology, safety and efficacy. I personally think that considering the contraindications to the use of Kambo, athletes should seek advice from their GP first before engaging with Kambo Practitioners. The addictive nature to Kambo may be a cause for concern for the athlete and the GP.

I do think that until we have a consensus on Kambo, or advice from sporting governing bodies, we should closely assess the athletes using Kambo at each event. I personally I think we should deter all athletes from using Kamba. There clearly needs to be a conversation about this. I am not sure how many people are aware of Kambo. I certainly was not until last week.

Further Reading – Schmidt, T.T., Reiche, S., Hage, C.L.C. et al. Acute and subacute psychoactive effects of Kambô, the secretion of the Amazonian Giant Maki Frog (Phyllomedusa bicolor): retrospective reports. Sci Rep 10, 21544 (2020). https://doi.org/10.1038/s41598-020-78527-4 https://www.nature.com/articles/s41598-020-78527-4

References

1. Hesselink JMK (2018) Kambo and its Multitude of Biological Effects: Adverse Events or Pharmacological Effects?. Int Arch Clin Pharmacol 4:017. doi.org/10.23937/2572-3987.1510017
2. Damila Rodrigues de Morais, Rafael Lanaro, Ingrid Lopes Barbosa, Jandyson Machado Santos, Kelly Francisco Cunha, et al. (2018) Ayahuasca and Kambo intoxication after alternative natural therapy for depression, confirmed by mass spectrometry. Forensic Toxicology 36: 212-221.
3. Keppel Hesselink JM (2018) Kambo: A ritualistic healing substance from an Amazonian frog and a source of new treatments. Open J Pain Med 2: 004-006.
4. Keppel Hesselink JM (2018) Kambô: A Shamanistic Ritual Arriving in the West-Description. Risks and Perception by the Users. Int J Psychol Psychoanal 4: 034.
5. Wilson DR (2020) What’s the Deal with Kambo and Frog Medicine? [online]. Available from https://www.healthline.com/health/kambo [Accessed 9th May 2021]
6. Daly M (2016) How Amazonian Tree Frog Poison Became the Latest Treatment for Addiction [online]. https://www.vice.com/en/article/gqkxa9/kambo-ceremony-alcoholism-purging-uk [Accessed 9th May 2021]
7. World Anti-Doping Agency (2021). List of Prohibited Substances and Methods [online]. Available from https://www.wada-ama.org/en/media/news/2021-01/wada-2021-list-of-prohibited-substances-and-methods-now-in-force [Accessed 9th May 2021}