Bitter Brew
Want to know what compound from the Amazon combines 2 plants in a bit of ingenious indigenous pharmacology? What substance was considered too dangerous for study in communist countries?
This is the Pick Your Poison podcast. I’m your host Dr. JP and I’m here to share my passion for poisons in this interactive show. Will our patient survive this podcast? It’s up to you and the choices you make. Our episode today is called Bitter Brew. Want to know what compound from the Amazon combines 2 plants in a bit of ingenious indigenous pharmacology? What substance was considered too dangerous for study in communist countries?
Today’s episode starts in a taxi. Things have been rough at work lately, so you’re happy to be on vacation even though you are racing to the airport directly from a night shift, swearing to yourself never to cut it so close again. Entirely predictably, you got a cardiac arrest minutes before the end of your shift, causing you to leave an hour late. The flight to Lima, Peru is, of course, on time. You run to the gate, promising yourself no more stress for the rest of the week and a trip to a place you’ve always dreamed of seeing, Machu Picchu.
You wave and shout frantically to the agents closing the gate. They hold the door. You heave a sigh of relief as you jam your bag into an overhead bin and flop into the seat next to your friend. You adjust your neck pillow and pull up the blanket. It’s going to be a long flight, hopefully you can sleep for some of it.
Then you notice your friend’s tear-stained face. She’s staring blankly at her phone. You ask what’s wrong. She says her boyfriend of five years just texted, ending their relationship. You silently remember all the things you never liked about him anyway. She cries for the entire flight. As the plane circles over Lima perched on the edge of the Pacific Ocean, you hope walking around the beautiful city and some good food will provide at least a little distraction.
Three days later, she’s barely left the hotel room. Tomorrow, you have tickets for a train to Machu Picchu. Except your friend announces a new plan. She’s decided to re-evaluate her entire life and determined the best way to find the answers is via a spiritual journey. Not one involving a train, but rather a journey into the mind. You assume she means here in Lima. She says no. It has to be a legitimate experience in the jungle. Furthermore, she’s already booked a 2-day trip.
Normally, you'd have no issue with a friend taking a solo side trip, but she is not herself and wandering around in the jungle doing mind-altering substances -alone- isn’t a great plan. You've no interest in the spiritual journey, but decide to be there for the trip. You set out for the jungle, imagining everything that could possibly go wrong in this remote location.
The lodging is a guest house basic and sparsely furnished, but clean. In the evening, as the sun sets and the sounds of the jungle come alive, you walk to a nearby hut. A tiny, wrinkled Peruvian woman greets you. The shaman. Her assistant directs you to find a spot on one of the yoga mats on the floor.
You sit down, noting each mat has a bucket on the end. You look for the bathroom, noting running water that’s good. But it’s only one bathroom and there are 20 yoga mats, not an ideal ratio.
“What are the buckets for?” your friend whispers. Uh oh, she hasn't done her homework and is in for a big surprise. In the corner, on the floor is a hot plate. A pot bubbles with a brow liquid. It looks like mud. The assistant starts playing the drums and chanting softy.
This spiritual journey in the Amazon rainforest, is a mixture of two plants. It’s a centuries old, probably older, absolutely ingenious bit of indigenous pharmacology.
Question #1. Time to Pick Your Poison. This is?
Peyote ie mescaline
LSD
Ecstasy, ie MDMA
Ayahuasca
Answer: D Ayahuasca. The others are a single substance.
Ayahuasca is a mixture of plants used by indigenous people in the Amazon rainforest. The mixture is a decoction of the stems of the Banisteriopsis caapi vine and the leaves of the Psychotria viridis shrub. Psychotria viridis, common name chacruna, contains dimethyltryptamine or DMT for short. It’s a hallucinogen. Why not just take it by itself? Because DMT doesn’t work if you eat it. If you ingest it, it’s broken down and inactivated via several pathways, including by an enzyme called monoamine oxidase. Taken alone, DMT itself never reaches your brain and nothing happens. The ingenious part is the addition of Banisteriopsis caapi, also known as the yage vine. The vine contains harmaline which is a monoamine oxidase inhibitor. Meaning, if you take the two together, harmaline in the vine prevents breakdown of the DMT in the plant, leading to psychoactive effects. Amazing!
It’s pretty incredible people were able to figure this out hundreds possibly thousands of years ago. Documented use of ayahuasca dates back several hundred years, at least as far back as the 1700s when it was recorded in letters from Jesuit missionaries.
I love the original name given in 1905 to harmaline, it was originally called telepathine. Sometimes the world we live in is a weird place. Random aside, one of the first researchers to study DMT was a Hungarian chemist and psychologist Stephen Szára in the 1950s. Why DMT? He wanted to research LSD and ordered some from Swiss company Sandoz. They denied his request claiming hallucinogens were too dangerous for communist countries, so he switched to DMT instead.
Anyway, some evidence of ayahuasca use is even older. There’s a really cool study in the journal PNAS analyzing the contents of a 1,000-year ritual bundle found in the Andes. What was in it? Inside a pouch made of fox snouts, yes, were traces of DMT and harmaline, cocaine and bufotenin, a hallucinogen found in toads. Can you imagine?
In modern times, what writer popularized ayahuasca with a book about seeking treatment for opioid use disorder? That’s Question 4 and today’s Pop Culture Consult.
Jack Kerouac
Allen Ginsberg
William S. Burroughs
Hunter S. Thompson
Answer: C William S. Burroughs in the Yage Letters. He said he felt like a snake vomiting out the universe.
Back to your vacation. The hut darkens as the sun drops below the horizon. Candles are lit. The shaman beckons participants forward, giving each a shot glass full of the thick brew.
You lean toward your friend and whisper, “Dose it to nausea and vomiting. Once you start vomiting, stop drinking.” The brew is homemade. The potency is widely variable given how it's cooked, what exactly it's made with, and the concentration of the compound within the actual plants. Dosing to affect is a best way to get the desired effects.
Her eyes widen and she bites her lip.
“It's not too late to change your mind,” you whisper.
She shakes her head and gets up to get the ayahuasca.
You make yourself comfortable on the yoga mat, stretching out and using your bag as a pillow. You’re only there in case something happens or your friend freaks out. The shaman notes your lack of participation. She beckons you up and when you pretend not to notice, she brings you a glass and stands there, waiting for you to drink. You bring the shot glass up to your lips. The smell is so vile there's no need to fake the retching. You grabbed the bucket and dump the brew in, hoping it’s too dark for her to see.
Other than the drum beats, the room becomes quiet. You read the sign on the wall. In huge letters, in English, it says no sex, no salt, no sugar, no spicy food, no oil. There were similar signs at the ayahuasca cafes in Lima. Your mind wanders wondering where these rules come from. There are precautions you have to take before doing ayahuasca. Ones you reviewed with your friend before setting out. What might be dangerous in combination with ayahuasca? That’s Question # 2.
Alcohol
Cheese
Peanuts
Aspirin
Answer: B. Cheese. As I mentioned earlier, ayahuasca is a combination of two things DMT, the psychedelic drug, and harmaline, a monoamine oxidase inhibitor preventing its breakdown after ingestion.
Let me take a minute to explain this. There are pharmaceutical drugs which are also monoamine oxidase inhibitors, such as older generation antidepressants like phenelzine and tranylcypromine (ie Parnate and Nardil). If you take a monoamine oxidase inhibitor and eat foods containing tyramine, it can result a life-threatening reaction. Tyramine is a substance found in foods like aged cheese, fermented foods and alcohol. It’s broken down after ingestion by monoamine oxidase. If you are taking a drug blocking the breakdown, it can result in a hypertensive crisis, meaning dangerously high blood pressure and even a stroke.
This risk is real with pharmaceutical monoamine oxidase inhibitors. With ayahuasca it’s unclear if this risk is real or more theoretical, but thus the recommendations as a precaution. Similarly, there is a potential, but not definitively proven, risk of serotonin syndrome if you’re taking a modern antidepressant like Prozac.
I don’t know where the other “rules” come from. According to the internet, you will need all of your energy for the experience and therefore shouldn’t waste it on activities like sex beforehand. The restriction on spicy food might have to do with the burn of vomiting it back up during the ceremony.
Your friend starts retching then vomits into the bucket, as do many of the other participants. To distract yourself from the urge to vomit yourself, thanks to the smell, you think about pharmacology. DMT is a hallucinogen, like LSD and psilocybin from mushrooms.
How do hallucinogens work? That’s question #3. By increasing levels of which neurotransmitter?
Dopamine
Epinephrine
Gaba
Serotonin
Answer: D serotonin. They are thought to work by increasing the levels in the brain. In fact, the structure of DMT is similar to the structure of serotonin. Dopamine is the reward pathway and associated with things like cocaine and meth, they also cause release of epinephrine ie adrenaline. Increased gaba is modulated by sedatives like alcohol and benzodiazepines. Ayahuasca is considered an entheogen. An interesting name for a class of compounds causing spiritual experiences.
Your friend is moaning and crying. Another participant is saying no, no, no over and over again. Several people appear calm and relaxed, others have expressions of horror on their faces. Many users of DMT say they see their own deaths. The word ayahuasca comes from the Quechua language with aya meaning spirit or corpse and wasca meaning vine. So loosely translated spirit vine, or vine of the dead.
Using ayahuasca has been described as a spiritual journey with death of the ego, processing of traumatic events and rebirth with a reawakening and new understanding. There’s an interesting hypothesis that naturally occurring DMT is the cause of near-death experiences given the similarity reported by users, though this is unproven.
Your friend is writhing around on the yoga mat with a grimace on her face. Ayahuasca experiences typically last around 4-6 hours, though the duration of DMT itself is short. DMT can be taken take it by itself, usually synthesized in a lab, rather than plant based. It has to be inhaled or vaped instead of ingested for reasons we already mentioned. It’s sometimes called the business man’s lunch because the duration of action is so short, less than 1 hour. After using ayahuasca, some people report ongoing psychological effects lasting weeks, including reduced anxiety, depression, and suicidal thoughts, though this doesn’t happen to everyone and whether is an actual effect of the compound remains unproven.
PET scans of people taking ayahuasca suggest increased activity regions of the brain related to emotional arousal and processing. Interestingly, it stimulates the same areas of the brain stimulated by the eyes, probably contributing to the vividness of the hallucinations.
A woman screams and runs out of the hut. One of the assistant’s follows her. Is ayahuasca dangerous? Nausea, vomiting, diarrhea, near death experiences and hallucinations are common. Seizures are possible, though rare. Like other hallucinogens it can triggers psychosis, though not without predisposing factors.
The US embassy in Peru has issued a warning in Jan 2025 citing negative health effects, but also warning of other dangers. There are risks not directly caused by the drug itself, including crimes perpetrated by others while victims have an altered mental status, including sexual assault, robbery, and motor vehicle accidents. In one case, a man believed another participant was sleeping with his wife, attacked him and was killed by the second participant in self-defense.
As with all unregulated substances, you might not get what you paid for. There are reports of additional things being added to make the experience "stronger "for tourists. One is toe, Brugmansia, or the angels trumpet from the nightshade family. It contains scopolamine and atropine, potentially causing anticholinergic side effects and significantly increasing the risk of overall toxicity.
Is ayahuasca legal? It varies. In Peru and Brazil, it’s legal. It’s illegal in much of Europe. In the US, religious use is allowed similarly to peyote.
Back to our friend. After five long hours sitting on the yoga mat, alone with your own thoughts, she begins to return to baseline. On the walk back to the guest house, she says she feels she gained some of the insights she was seeking, but has a lot more thinking to do and thanks you for coming with her. She say’s she’ll get tickets for the train to Macchu Picchu as soon as you get back to Lima. A few days later, high in the Andes, fresh air, scenic vistas and the incredible remains of the ancient civilization does wonders for your own mental health.
The last question in today’s podcast. #5. Which of the following celebrities have reported using ayahuasca?
Prince Harry
Will Smith
Sting
Beyonce
Taylor Swift
Follow the Twitter and Instagram feeds both @pickpoison1 for the answer. Remember, never try anything on this podcast at home or anywhere else.
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